Desfechos Hospitalares do Infarto do Miocárdio com Supradesnivelamento do Segmento ST em Pacientes Positivos para COVID-19 que Passaram por Intervenção Percutânea Primária / In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction in COVID-19 Positive Patients Undergoing Primary Percutaneous Intervention

Resumo Fundamento A infecção concomitante por coronavírus 2019 (COVID-19) e o infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) estão associados ao aumento de desfechos adversos hospitalares. Objetivos O estudo teve como objetivo avaliar as diferenças angiográficas, de procedimentos, laboratoriais e prognósticas em pacientes positivos e negativos para COVID-19 com IAMCSST submetidos à intervenção coronária percutânea primária (ICP). Métodos Realizamos um estudo observacional retrospectivo e unicêntrico entre novembro de 2020 e agosto de 2022 em um hospital de nível terciário. De acordo com o seu estado, os pacientes foram divididos em dois grupos (positivo ou negativo para COVID-19). Todos os pacientes foram internados por IAMCSST confirmado e foram tratados com ICP primária. Os desfechos hospitalares e angiográficos foram comparados entre os dois grupos. P-valores bilaterais <0,05 foram aceitos como estatisticamente significativos. Resultados Dos 494 pacientes com IAMCSST inscritos nesse estudo, 42 foram identificados como positivos para COVID-19 (8,5%) e 452, como negativos. Os pacientes que testaram positivos para COVID-19 tiveram um tempo isquêmico total maior do que os pacientes que testaram negativos para COVID-19 (p = 0,006). Além disso, esses pacientes apresetaram um aumento na trombose de stent (7,1% vs. 1,7%, p = 0,002), no tempo de internação (4 dias vs. 3 dias, p = 0,018), no choque cardiogênico (14,2% vs. 5,5%, p = 0,023) e na mortalidade hospitalar total e cardíaca (p <0,001 e p = 0,032, respectivamente). Conclusões Pacientes com IAMCSST com infecções concomitantes por COVID-19 foram associados ao aumento de eventos cardíacos adversos maiores. Mais estudos são necessários para compreender os mecanismos exatos dos desfechos adversos nesses pacientes.

Abstract Background Concomitant coronavirus 2019 (COVID-19) infection and ST-segment elevation myocardial infarction (STEMI) are associated with increased adverse in-hospital outcomes. Objectives This study aimded to evaluate the angiographic, procedural, laboratory, and prognostic differences in COVID-19-positive and negative patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods A single-center, retrospective, observational study was conducted between November 2020 and August 2022 in a tertiary-level hospital. According to their status, patients were divided into two groups (COVID-19 positive and negative). All patients were admitted due to confirmed STEMI and treated with primary PCI. In-hospital and angiographic outcomes were compared between the two groups. Two-sided p-values < 0.05 were accepted as statistically significant. Results Of the 494 STEMI patients enrolled in this study, 42 were identified as having a positive dagnosis for COVID-19 (8.5%), while 452 were negative. The patients who tested positive for COVID-19 had a longer total ischemic time than did those who tested negative for COVID-19 (p=0.006). Moreover, these patients presented an increase in stent thrombosis (7.1% vs. 1.7%, p=0.002), length of hospitalization (4 days vs. 3 days, p= 0.018), cardiogenic shock (14.2% vs. 5.5 %, p= 0.023), and in-hospital total and cardiac mortality (p<0.001 and p=0.032, respectively). Conclusions Patients with STEMI with concomitant COVID-19 infections were associated with increased major adverse cardiac events. Further studies are needed to understand the exact mechanisms of adverse outcomes in these patients.

Effect of Ticagrelor on Left Ventricular Function in Patients with Mildly Reduced Ejection Fraction after Acute Myocardial Infarction

Abstract Background There are limited data about the effect of new P2Y12 inhibitors on left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Objectives We aimed to investigate the effect of ticagrelor on left ventricular function, compared to clopidogrel in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after AMI. Methods In this cross-sectional, single-center study, we included 251 patients with LVEF between 40% and 50% after AMI before discharge. The patients were divided into 2 groups according to the use of ticagrelor (166 patients) and clopidogrel (85 patients). At the end of the 12-month period, LVEF changes were assessed by echocardiography. P < 0.05 was considered statistically significant. Results The mean LVEF before discharge was 46.5% ± 3.6%, and no difference was observed between the ticagrelor and clopidogrel groups (p = 0.20). At the end of the first year, the mean LVEF of the patients increased to 49.8% ± 7.6% in both groups. The use of ticagrelor (β ± SE = 2.05 ± 0.93; p = 0.029), low creatinine level (β ± SE = −10.44 ± 2.35; p < 0.001), low troponin level (β ± SE = −0.38 ± 0.14; p = 0.006), and low heart rate (β ± SE = −0.98 ± 0.33; p = 0.003) were found to be independent predictors of the increase in LVEF (β ± SE 2.05 ± 0.93; 95% confidence interval: 0.21 to 3.90; p = 0.029). Conclusion In our study, ticagrelor improved left ventricular function in 12 months follow-up compared to clopidogrel in patients with HFmrEF after AMI.

Neutrófilos en el diagnóstico de infarto del miocardio tipo 4a / Neutrophils in the Diagnosis of Type 4 Myocardial Infarction

Introducción: El infarto del miocardio tipo 4a es una complicación del intervencionismo coronario percutáneo que incrementa el estado inflamatorio de los pacientes. Objetivo: Evaluar el valor diagnóstico del conteo absoluto de neutrófilos en la aparición de infarto del miocardio tipo 4a. Métodos: Se realizó una cohorte prospectiva en el Hospital Hermanos Ameijeiras. El universo estuvo constituido por 412 pacientes a los que se les realizó intervencionismo coronario percutáneo en el período comprendido de noviembre de 2018 a enero de 2021, la muestra fue de 232 pacientes. Se definieron variables clínicas, anatómicas, e inflamatorias. Resultados: Existieron diferencias significativas entre los pacientes con infarto tipo 4a y los que no tuvieron esta complicación según las variables clínicas: edad, índice de masa corporal, diabetes mellitus, enfermedad renal crónica y disfunción sistólica ventricular. La elevación del conteo absoluto de neutrófilos posterior al proceder con un área bajo la curva de 0,947 tuvo buena capacidad de discriminación de esta complicación (p = 0,000). En el diagnóstico de infarto periproceder el conteo absoluto de neutrófilos fue 7,35 posterior al proceder, tuvo una sensibilidad de 91,3 por ciento una especificidad de 96,2 por ciento. Conclusiones: Los neutrófilos fueron sensibles y específicos para el diagnóstico de infarto del miocardio tipo 4a(AU)

Introduction: Type 4 myocardial infarction is a complication of percutaneous coronary intervention that increases the inflammatory state of patients. Objective: To evaluate the diagnostic value of the absolute neutrophil count in the occurrence of type 4 myocardial infarction. Methods: A prospective cohort was carried out at Hermanos Ameijeiras Clinical Surgical Hospital. The universe consisted of 412 patients who underwent percutaneous coronary intervention from November 2018 to January 2021, two hundred thirty-two (232) patients form the sample. Clinical, anatomical and inflammatory variables were defined. Results: There were significant differences between patients with type 4 infarction and those who did not have this complication according to the clinical variables such as age, body mass index, diabetes mellitus, chronic kidney disease and ventricular systolic dysfunction. The subsequent elevation of the absolute neutrophil count when proceeding with an area under the 0.947 curve had good ability to discriminate this complication (p = 0.000). In the diagnosis of periprocedural infarction, the absolute neutrophil count was ≥ 7.35 after the procedure, it had 91.3percent sensitivity and 96.2percent specificity. Conclusions: Neutrophils were sensitive and specific for the diagnosis of type 4 myocardial infarction(AU)

Characteristics of ST-Elevation Myocardial Infarction during the SARS-CoV-2 Outbreak

Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment-elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however.

Hemostasis Using Prothrombin Complex Concentrate in Patients Undergoing Cardiac Surgery: Systematic Review with Meta-Analysis

ABSTRACT Objective: The purpose of present study was to comprehensively explore the efficacy and safety of prothrombin complex concentrate (PCC) to treat massive bleeding in patients undergoing cardiac surgery. Methods: PubMed®, Embase, and Cochrane Library databases were searched for studies investigating PCC administration during cardiac surgery published before September 10, 2022. Mean difference (MD) with 95% confidence interval (CI) was applied to analyze continuous data, and dichotomous data were analyzed as risk ratio (RR) with 95% CI. Results: Twelve studies were included in the meta-analysis. Compared with other non-PCC treatment regimens, PCC was not associated with elevated mortality (RR=1.18, 95% CI=0.86-1.60, P=0.30, I2=0%), shorter hospital stay (MD=-2.17 days; 95% CI=-5.62-1.28, P=0.22, I2=91%), reduced total thoracic drainage (MD=-67.94 ml, 95% CI=-239.52-103.65, P=0.44, I2=91%), thromboembolic events (RR=1.10, 95% CI=0.74-1.65, P=0.63, I2=39%), increase in atrial fibrillation events (RR=0.73, 95% CI=0.52-1.05, P=0.24, I2=29%), and myocardial infarction (RR=1.10, 95% CI=0.80-1.51, P=0.57, I2=81%). However, PCC use was associated with reduced intensive care unit length of stay (MD=-0.81 days, 95% CI=-1.48- -0.13, P=0.02, I2=0%), bleeding (MD=-248.67 ml, 95% CI=-465.36- -31.97, P=0.02, I2=84%), and intra-aortic balloon pump/extracorporeal membrane oxygenation (RR=0.65, 95% CI=0.42-0.996, P=0.05, I2=0%) when compared with non-PCC treatment regimens. Conclusion: The use of PCC in cardiac surgery did not correlate with mortality, length of hospital stay, thoracic drainage, atrial fibrillation, myocardial infarction, and thromboembolic events. However, PCC significantly improved postoperative intensive care unit length of stay, bleeding, and intra-aortic balloon pump/ extracorporeal membrane oxygenation outcomes in patients undergoing cardiac surgery.

Quality of acute coronary syndrome care and in hospital outcome in a resource-poor setting in Northern Ghana

Introduction: African countries are facing an epidemic of cardiovascular diseases. Information on the quality of acute coronary syndrome care offered in underserved communities in Ghana is limited. Using objective criteria, we examined the quality of acute coronary syndrome care offered to patients presenting to a tertiary referral center in Northern Ghana. Methods: we conducted a retrospective review of patients ≥ 18 years old with acute coronary syndrome managed in Tamale Teaching Hospital. We assessed in-hospital outcomes and the extent of compliance to key performance and quality indicators as contained in the 2017 American Heart Association/American College of Cardiology guideline for adults with myocardial infarction. Results: sixty-two (62) patients with a mean age of 56.0 ± 16.1 years were recruited. The median delay to presentation was 24 hours (IQR 15-96 hours). 33.9% had ST-elevation myocardial infarction, of which only 14.3% received reperfusion therapy. About three-quarters of patients received dual antiplatelet therapy at discharge, with fewer patients receiving recommended high-intensity statin therapy (65.5%) or beta-blockers (69.1%). Only 38.2% of patients had their left ventricular ejection fraction documented. No cardiac rehabilitation program existed. Risk stratification of patients with non-ST-elevation myocardial infarction or stress testing for conservatively managed patients was not part of routine practice. Conclusion: acute coronary syndrome management remains a challenging issue in Northern Ghana. Several gaps exist in the care quality, timeliness of interventions and rehabilitation of affected patients. There is an urgent need for measures to improve the delivery of acute coronary syndrome care alongside primary prevention strategies.

Effects of alfentanil on myocardial fibrosis in rats with acute myocardial infarction by regulating the SphK1/S1P signaling pathway / 中国药房

OBJECTIVE To explore the effects of alfentanil （ALF） on myocardial fibrosis in rats with acute myocardial infarction （AMI） by regulating sphingosine kinase 1 （SphK1）/sphingosine 1-phosphate （S1P） signaling pathway. METHODS Male SD rats were collected to construct AMI model by the ligation of anterior descending branch of left coronary artery. The successfully modeled rats were randomly divided into AMI model group （Model group）， ALF low-dose group （ALF-L group， 0.25 mg/kg ALF）， ALF high-dose group （ALF-H group， 0.5 mg/kg ALF）， high dose of ALF+SphK1 activator group （ALF-H+K6PC-5 group， 0.5 mg/kg ALF+1 μg/g K6PC-5）. At the same time， a sham operation group （Sham group） was set up to perform only chest opening/closing operations without ligating the anterior descending branch of left coronary artery， with 15 rats in each group. Rats in each drug group were intraperitoneally injected with the corresponding drug solution， once a day， for 4 consecutive weeks. Twelve hours after the last medication， cardiac function indicators [left ventricular systolic pressure （LVSP）， left ventricular ejection fraction （LVEF）， left ventricular systolic diameter （LVSD）， left ventricular fractional shortening （LVFS）] of rats were detected in each group； the condition of myocardial infarction， pathological changes in myocardial tissue， and degree of fibrosis were observed； serum levels of brain natriuretic peptide （BNP） and cardiac troponin Ⅰ （cTnⅠ） in rats were detected. The protein expressions of collagen Ⅰ ， collagen Ⅲ ， matrix metalloproteinase-2 （MMP-2）， SphK1 and S1P were alsodetected in the myocardial tissue of rats. RESULTS Compared with the Sham group， the arrangement of myocardial cells in the Model group was disordered， with a large number of inflammatory cells infiltrating. The levels of LVSP， LVFS and LVEF in the Model group were significantly reduced （P＜0.05）； LVSD level， myocardial infarction area， collagen volume fraction， serum levels of BNP and cTnⅠ， the protein expressions of collagen Ⅰ， collagen Ⅲ， MMP-2， SphK1 and S1P in myocardial tissue were significantly increased or enlarged （P＜0.05）. Compared with the Model group， the pathological changes and degree of fibrosis in the myocardial tissue of rats in each dose group of ALF were improved or relieved， while the quantitative indicators of rats in the ALF-H group were significantly improved and significantly better than those in ALF-L group （P＜0.05）. K6PC-5 could significantly reverse the improvement effect of high-dose ALF on the above quantitative indicators in rats （P＜0.05）. CONCLUSIONS ALF can reduce myocardial fibrosis and improve cardiac function in AMI rats， and the effect may be related to the inhibition of the SphK1/S1P signaling pathway.

The regulatory effect of morphine postconditioning in left stellate ganglion on remodeling after myocardial infarction / 中国药理学通报

Aim To investigate the regulatory effect of morphine postconditioning in the LSG on remodeling after myocardial infarction. Methods SD rats were randomly divided into four groups: sham operation group (Sham), myocardial infarction group (MI), myocardial infarction + saline group (Control) and myocardial infarction + morphine postconditioning group (MI + Morphine) . The rat MI model was constructed by ligating the left anterior descending coronary artery, and then morphine was given to the LSG by percutaneous posterior approach. After four weeks, the changes of cardiac function in rats were detected by ultrasound. Masson staining was used to detect fibrosis changes; the expression of Collagen I and Collagen III protein was detected by Western blot. The mRNA expression of ANP and BNP was detected by RT-qPCR. The expression of JJLOR in LSG was detected by immunofluorescence. The concentration of catecholamine in plasma and myocardial tissue was detected by ELISA. Results Compared with the sham group, the cardiac function of the MI group was significantly impaired, the myocardial tissue showed significant fibrosis changes, and the concentration of catecholamine in plasma and myocardial tissue significantly increased. Compared with the control group, the MI + Morphine group reduced myocardial fibrosis collagen deposition in rats after MI, inhibited the expression of ANP and BNP in myocardial tissue, reduced the concentration of catecholamine, and improved the cardiac function of MI rats. Immunofluorescence results showed that JJLOR was expressed in LSG after MI and increased after morphine postconditioning. Conclusions This study shows that morphine postconditioning in the LSG has a protective effect on myocardial remodeling after myocardial infarction. The mechanism may be related to the activation of JJLOR in the LSG by morphine and the reduction of catecholamine release from sympathetic nerve endings.

Cardiocerebral infarction presenting as Opalski Syndrome: A case report

Introduction@#Opalski Syndrome is a rare type of stroke variant presenting with signs of lateral medullary syndrome plus ipsilateral hemiparesis. A confirmed myocardial infarction simultaneously occurring with this acute ischemic stroke syndrome makes this an even more challenging case of Cardiocerebral infarction.@*Case@#The patient is a 48-year-old female, a known diabetic and asthmatic, and was seen due to a 3-day history of sudden onset of non-rotatory dizziness associated with diplopia, non-projectile vomiting, numbness of the left side of the face and lingual dysarthria. She was initially admitted in a primary hospital wherein she developed chest pain, dyspnea and diaphoresis. She was transferred and was received with findings of miosis of the left eye, rotational nystagmus, left dysmetria, decreased pain and temperature sensation on the right extremities, left central facial palsy, tongue deviation to the left side, left hemiparesis and upward Babinski on the left. We localize this lesion on the left lateral medullary area with involvement of the caudal left corticospinal tract. Hence, a clinical impression of Opalski Syndrome was made. This was confirmed with cranial MRI findings of T2/FLAIR hyperintense focus involving the left lateral aspect of the medulla. The patient’s Troponin I was also elevated and she was managed as a case of acute coronary syndrome - NSTEMI. Hence, a diagnosis of Type III Cardiocerebral infarction was made. Medical intervention was started with dual antiplatelet therapy and anticoagulation with noted clinical improvement. @*Conclusion@#This case report highlights the diagnosis of Opalski Syndrome in a patient also presenting with Cardiocerebral infarction. There should be prompt recognition of the following disease entities to have an effective treatment, avoid cardiac and neurologic sequelae, and achieve an overall favorable prognosis.

A cross-sectional study on the association of red cell distribution width and Acute Coronary Syndrome among patients admitted to the Bataan General Hospital and Medical Center

Introduction@#Red cell distribution width (RDW) is a parameter that is readily available as part of a standard complete blood count (CBC). Studies have shown that an elevated RDW is associated with increased cardiovascular events including acute coronary syndrome (ACS). This cross- sectional retrospective study was conducted to determine the association of RDW in patients with ACS admitted to Bataan General Hospital and Medical Center (BGHMC).@*Methods@#A cross-sectional study was performed in a 500-bed tertiary care hospital in Bataan, Philippines. The clinical medical records of patients with ACS were analyzed retrospectively. A total of 811 patients was admitted as cases of ACS from January 2017 to December 2019. Using Slovin’s formula, the computed sample size was 261 patients. However, only 205 cases were included in the study in accordance to the eligibility criteria. The baseline RDW were recorded from the CBC obtained upon admission of patients with ACS.@*Results@#Based on the data collected from January 2017 to December 2019 from patients admitted to BGHMC, there was no significant association between RDW and in-house morbidity and mortality and classification of ACS.@*Conclusions@#There were no significant association between RDW and in-house morbidity and mortality and classification of ACS. The authors recommend to conduct the study for a longer duration to have more population included and to include other parameters such as cardiac enzymes, electrocardiogram (ECG) changes and presence of co-morbidities.

Related factors of post-stroke depression in patients with cerebral infarction during hospitalization in rehabilitation department / 中国康复理论与实践

ObjectTo explore the risk factors related to the intensity of post-stroke depression in patients with cerebral infarction during hospitalization in the rehabilitation department. MethodsThe hospital consultation records of cerebral infarction patients in Beijing Bo'ai Hospital from December, 2019 to February, 2023 were reviewed from the hospital information system, and those who were diagnosed as depression visited the department of psychology were selected. It was collected including general information of sexes, ages, education levels, matrimony; medical features of course, location, affected side, sensory disorders, aphasia, agrypnia, dysphagia, hand-shoulder syndrome, constipation; functioning of muscle strength and Brunnstrom stages; and scores of Mini-Mental State Examination (MMSE), National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Fugl-Meyer Assessment-Balance (FMA-B), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Patients with HAMD scores ≤ 20 were as the low group, and those > 20 were as the high group. ResultA total of 2 403 hospitalized stroke patients were included, out of which 269 patients with cerebral infarction were diagnosed as depression and visited the department of psychology; while 103 cases were in the low group and 166 cases were in the high group. The incidence of constipation was less, and the incidence of dysphagia and shoulder-hand syndrome was higher in the high group (χ2 > 5.379, P < 0.05), with weaker strength of iliopsoas muscle and quadriceps muscle, earlier of Brunnstrom stage of lower extremities and hands, and worse scores of NIHSS, MMSE, FMA, FMA-B and MBI (|Z| > 2.020, t > 2.171, P < 0.05). Logistic regression showed that constipation (OR = 0.435), quadriceps muscle strength (OR = 0.782) and dysphagia (OR = 2.602) related to the intensity of post-stroke depression in convalescent patients (P < 0.05). ConclusionPost-stroke dysphagia and poor quadriceps muscle strength may exacerbate post-stroke depression; however, constipation may not.

Study on the treatment of cerebral infarction with Chinese medicine Shenmajingfu granule by network pharmacology / 药学实践杂志

Objective To explore the material basis and mechanism of the Chinese medicine Shenmajingfu granules in the treatment of cerebral infarction. Methods The potential active ingredients and targets of Shenmajingfu granules were retrieved through TCMSP, ETCM database and TCM Database. The related target genes of cerebral infarction were searched from OMIM database. The common targets of Shenmajingfu granules and cerebral infarction were obtained by the intersection method. Cytoscape was used to construct active components of Shenmajingfu granules-targets network. Protein-protein interaction network was constructed by STRING software. DAVID database was used for GO and KEGG enrichment analysis. Results The 183 potential active ingredients of Shenmajingfu granules were screened out. 1785 potential targets were screened in the TCMSP database, including 30 targets related to cerebral infarction. These target genes were mainly involved in the inflammatory response and apoptosis process, involving the TNF signaling pathway, HIF-1 signaling pathway and NF-κB signaling pathway. Conclusion The therapeutic effect of Shenmajingfu granules on cerebral infarction may be related to the regulation of inflammatory response, improvement of impaired neurological function and protection of cerebral ischemia-reperfusion injury.

Establishment and Evaluation of Animal Model of Acute Myocardial Infarction with Syndrome of Qi and Yin Deficiency / 中国实验方剂学杂志

ObjectiveTo explore the establishment and evaluation methods of the rat model of acute myocardial infarction （AMI） in coronary heart disease with the syndrome of Qi and Yin deficiency by sleep deprivation （SD） combined with isoproterenol （ISO） and preliminarily explore its biological basis. MethodForty SD rats were assigned into normal （no treatment）， SD （treatment in modified multi-platform water environment for 96 h）， ISO （subcutaneous injection of ISO at 100 mg·kg-1 once every other day for a total of 2 times）， and SD+ISO （injection of 100 mg·kg-1 ISO after SD for 72 h and 96 h） groups. The cardiac function was detected by small animal echocardiography. The serum levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， and cardiac troponin T （cTnT） were measured by biochemical methods. The pathological changes of the myocardial tissue were observed by hematoxylin-eosin staining. The general state， body weight， grip strength， body temperature， behaviors in open field test， serum levels of cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， cAMP/cGMP ratio， red （R）， green （G）， blue （B） values of the tongue surface， and pulse amplitude were observed and measured to evaluate the modeling results. Enzyme-linked immunosorbent assay was employed to determine the serum levels of interleukin-18 （IL-18）， tumor necrosis factor-α （TNF-α）， superoxide dismutase （SOD）， malondialdehyde （MDA）， corticotropin-releasing factor （CRF）， adrenocorticotropic hormone （ACTH）， triiodothyronine （T3）， tetraiodothyronine （T4）， cluster of differentiation 4 （CD4）， and cluster of differentiation 8 （CD8）. ResultIn terms of disease indicators， the ISO and SD+ISO groups had lower cardiac function indicators than the normal group （P<0.01）. The levels of CK， CM-MB， LDH and cTnT elevated in each model group compared with the normal group （P<0.01）. The pathological changes of myocardial tissue were obvious in the ISO and SD+ISO groups. In terms of syndrome indicators， compared with the normal group， the SD and SD+ISO groups showed decreased body weight at each time point （P<0.01）， and the ISO group showed decreased body weight at the time points of 48 h and 72 h （P<0.05， P<0.01）. The paw temperature and rectal temperature increased in the SD group （P<0.01）. The model groups showed weakened grasp strength， lowered R， G， and B values of the tongue surface （P<0.01）， prolonged immobility time （P<0.01）， reduced total distance and number of entering the central area （P<0.01）， decreased average speed （P<0.05， P<0.01）， and increased cAMP and cGMP （P<0.05， P<0.01）. The cAMP/cGMP ratio was increased in the SD+ISO group （P<0.01）， and the pulse amplitude was decreased in the SD and SD+ISO groups （P<0.01）. In terms of serological indicators，compared with the normal group， the levels of IL-18， TNF-α， SOD and MDA were significantly increased in the ISO and SD+ISO groups （P<0.01）， the CRF， ACTH， CORT， T3， T4， CD4 and CD8 in the model groups were increased （P<0.05， P<0.01）. ConclusionSleep deprivation for 96 h combined with high-dose ISO can successfully establish a rat model of acute myocardial infarction in coronary heart disease with the syndrome of Qi and Yin deficiency. The model evaluation system can be built with disease indicators of western medicine， histopathological indicators， macroscopic indicators of traditional Chinese medicine， and serological indicators.

Comparison on Rat Models of Acute Cerebral Infarction Due to Stasis Combined with Toxin Complicated with Cerebral-cardiac Syndrome / 中国实验方剂学杂志

ObjectiveTo observe and compare the electrocardiogram index， myocardial morphology， and connexin 43 （Cx43） expression of two rat models of acute cerebral infarction （ACI） due to stasis combined with toxin complicated with cerebral-cardiac syndrome （CCS）， and to provide experimental evidence for the research on the occurrence mechanism of cardiac diseases induced by ACI and the clinical diagnosis and treatment of CCS. MethodSixty SPF-grade male SD rats were randomized into six groups （n=10）： normal ， syndrome of stasis combined with toxin induced by carrageenin combined with dry yeast （CA/Y）， multi-infarct induced by micro-embolism （ME）， middle cerebral artery occlusion （MCAO）， CA/Y+ME， and CA/Y+MCAO groups. The model of syndrome of stasis combined with toxin was established by intraperitoneal injection with carrageenan （CA） at 10 mg·kg-1 on the first day and subcutaneous injection with dry yeast （Y） suspension （2 mg·kg-1） on the second day of modeling. Twenty-four hours after the modeling of ACI， the electrocardiograms （ECGs） of rats in each group were collected and the number/percentage （%） of abnormal ECG was calculated. The infarct area of the brain was evaluated by 2，3，5-triphenyltetrazolium chloride （TTC） staining， and myocardial injury was assessed by hematoxylin-eosin （HE） staining. Immumohistochemical staining and Western blot were employed to determine the expression of Cx43 in the myocardium. ResultA certain number of rats in each model group presented abnormal ECG. Compared with the normal group and CA/Y group， CA/Y+MCAO group had the highest rate of abnormal ECG （P<0.01）. Compared with the normal， CA/Y， ME， and CA/Y+ME groups， the CA/Y+ME and CA/Y+MCAO groups showed decreased amplitudes of P-wave and T-wave， shortened P-R interval， and extended Q-T interval， which were particularly obvious in the CA/Y+MCAO group （P<0.05， P<0.01） and in accordance with the cerebral infarction area and pathological changes. The expression of Cx43 was up-regulated in both CA/Y+ME and CA/Y+MCAO groups， especially in the CA/Y+MCAO group （P<0.01）. ConclusionThe two rat models of ACI due to stasis combined with toxin complicated with CCS can be used to study the mechanism of heart diseases caused by cerebrovascular diseases and the therapeutic effects of Chinese medicines with the functions of resolving stasis and detoxifying. Moreover， the CA/Y+MCAO method has higher abnormal electrocardiogram rate， severer myocardial pathological injury， and higher expression of Cx43 protein. The models can be chosen according to specific experimental purpose.

Infarto agudo de miocardio y factores de riesgo predisponentes

Fundamento: más de siete millones de personas mueren cada año como consecuencia de la cardiopatía isquémica. La incidencia de factores de riesgo constituye una sobrecarga de actividad para el corazón lo que presupone un incremento en la ocurrencia de infarto del miocardio. Objetivo: determinar la epidemiología del infarto agudo de miocardio y factores de riesgo predisponentes. Método: se realizó un estudio descriptivo, analítico, longitudinal, retrospectivo de serie de casos a partir de la población con diagnóstico de infarto agudo de miocardio evaluados en el Servicio de Urgencias Médicas del Hospital Docente Clínico Quirúrgico Carlos Enrique Font de Banes, provincia Holguín durante el período mayo 2022- 2023. El universo abarcó 57 individuos diagnosticados. Por muestreo probabilístico aleatorio simple, se obtuvo la muestra de 38 casos. Se operacionalizaron las variables: edad, sexo, modalidad de infarto, factores de riesgo, riesgo cardiovascular global. Fueron utilizados los estadígrafos: Chi cuadrado de Pearson, Odd Ratio (OR), incluidos p e intervalo de confianza. Resultados: el sexo masculino prevaleció en un 63,1 %. El grupo de edades 60-69 años resultó el más afectado con un 31,6 %. El infarto agudo de miocardio doloroso fue de 71,1 % (OR=6), con elevación del ST 76,3 % (OR=10,3) y de cara posterior un 39,5 % obtuvo valores estadísticos elevados. Los factores de riesgo, hipertensión arterial (X2=25,4 OR=14 IC95 % (4,6; 42,3) y los antecedentes familiares de enfermedad cardiovascular (X2=5,2 OR=2,9 IC95 % (1,1; 7,4)) expresaron asociación altamente significativa para infarto agudo de miocardio. El riesgo cardiovascular global medio predominó (52,6 % OR=1,23 X2=0,21). Conclusiones: los individuos con infarto agudo de miocardio muestran un riesgo cardiovascular global medio a expensas de factores de riesgo prevenibles.

Foundation: more than seven million people die each year as a result of ischemic heart disease. The incidence of risk factors constitutes an overload of activity for the heart, which presupposes an increase in the occurrence of myocardial infarction. Objective: determine the epidemiology of acute myocardial infarction and predisposing risk factors. Method: a descriptive, analytical, longitudinal, retrospective study of a series of cases was carried out from the population with a diagnosis of acute myocardial infarction evaluated in the Medical Emergency Service of the Carlos Enrique Font Banes Clinical Surgical Teaching Hospital, Holguín province during the period May 2022-2023. The universe covered 57 diagnosed individuals. By simple random probabilistic sampling, a sample of 38 cases was obtained. The variables were operationalized: age, sex, type of infarction, risk factors, global cardiovascular risk. The following statisticians were used: Pearson's Chi square, Odd Ratio (OR), including p and confidence interval. Results: the male sex prevailed in 63.1 %. The age group 60-69 years old was the most affected with 31.6 %. Painful acute myocardial infarction was 71.1 % (OR=6), with ST elevation 76.3 % (OR=10.3) and on the posterior side 39.5 % obtained high statistical values. The risk factors, arterial hypertension (X2=25.4 OR=14 95 % CI (4.6; 42.3) and family history of cardiovascular disease (X2=5.2 OR=2.9 95 % CI (1, 1; 7.4)) expressed a highly significant association for acute myocardial infarction. The mean global cardiovascular risk predominated (52.6 % OR=1.23 X2=0.21). Conclusions: individuals with acute myocardial infarction show an average global cardiovascular risk at the expense of preventable risk factors.

Alta temprana en infarto agudo de miocardio con elevación del segmento ST tratado con angioplastia primaria: estudio de intervención no controlado en Argentina / Early Discharge in Acute ST-segment Elevation Myocardial Infarction Treated with Primary Angioplasty: Uncontrolled Intervention Study in Argentina

RESUMEN Introducción y objetivos: El alta hospitalaria temprana (dentro de las primeras 48 horas) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratados con angioplastia coronaria primaria con stent (ATCp) ha sido adoptada en países desarrollados. Sin embargo, su implementación en Sudamérica ha sido dispar. Material y métodos: Estudio piloto de intervención no controlado, argentino, de pacientes con IAMCEST de bajo riesgo tratados con ATCp, para evaluar tasa de alta temprana y comparar la incidencia de eventos cardiovasculares adversos mayores (MACE) con la que ocurre en pacientes externados en forma no temprana. Resultados: Desde 2013 hasta 2021 se trataron con ATCp 320 pacientes con IAMCEST, de los que 158 fueron de bajo riesgo. Alta temprana en 63,9% (IC 95% 55,9-71,4%). La diabetes (OR 0,31; IC 95% 0,12-0,83) y el IAMCEST anterior (OR 0,34; IC 95% 0,16-0,69) se asociaron en forma independiente con menor probabilidad de alta temprana. Durante una mediana de seguimiento de 27,2 meses, la razón de tasas de incidencia de MACE entre los grupos de alta temprana y no temprana fue de 0,77 (IC 95 % 0,25-2,58; p = 0,61). Las variables asociadas de forma independiente con MACE fueron la revascularización completa (HR 0,18; IC 95% 0,03-0,95) y el tiempo de fluoroscopía (HR 1,02; IC 95% 1,01-1,05). No hubo diferencias significativas en las complicaciones del acceso vascular, las tasas de reingreso a 30 días y sobrevida global entre los grupos. Conclusiones: El alta temprana en pacientes con IAMCEST de bajo riesgo tratados con ATCp puede ser factible incluso en países en desarrollo, sin aumento significativo de la morbimortalidad.

ABSTRACT Background and objectives: Early discharge (within the first 48 hours) in patients with ST-segment elevation myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (PCI) with stenting is a strategy that has been adopted in developed countries. However, its implementation in South America has been uneven. Methods: We conducted an uncontrolled intervention pilot study on low-risk STEMI patients managed with primary PCI to evaluate the early discharge rate and compare the incidence of major adverse cardiovascular events (MACE) with those occurring in patients discharged later. Results: Of 320 STEMI patients managed with primary PCI from 2013 to 2021, 158 were low-risk patients and 63.9% (95% CI 55.9-71,4%) of them were discharged early. Diabetes (OR 0.31, 95% CI 0.12-0.83), and anterior wall STEMI (OR 0.34, 95% CI 0.16-0.69) were independently associated with lower probability of early discharge. During a median follow-up period of 27.2 months, the incidence rate ratio of MACE between the early discharge and non-early discharge groups was 0.77 (95% CI 0.25-2.58; p = 0.61). The variables independently associated with MACE were complete revascularization (HR 0.18, 95% CI 0.03-0.95) and fluoroscopy time (HR 1.02, 95% CI 1.01-1.05). There were no significant differences in vascular access complications, 30-day readmission rate and overall survival between groups. Conclusions: Early discharge in low-risk STEMI patients managed with primary PCI may be feasible even in developing countries, without significantly increasing morbidity and mortality.

Registro ARGEN-IAM-ST: infarto de miocardio con elevación del segmento ST en el "nuevo" adulto mayor / ARGEN-IAM-ST Registry: ST-elevation myocardial infarction in "new" older adults

RESUMEN Introducción: La Organización Mundial de la Salud (OMS) considera adulto mayor (AM) a las personas que tienen 60 años o más. Es sabido que la mortalidad por infarto agudo de miocardio (IAM) aumenta a edades más avanzadas, pero siempre se han utilizado umbrales de edad mayores que el propuesto por la OMS, por lo cual describir las características y evolución intrahospitalaria de este subgrupo (de acuerdo con la definición de la OMS) se torna relevante. Objetivos: 1) conocer la prevalencia de los AM según la OMS, con IAM con elevación del segmento ST en Argentina y 2) com- parar sus características, tratamientos de reperfusión y mortalidad con los adultos jóvenes. Material y métodos: Se analizaron los pacientes ingresados en el Registro Nacional de Infarto (ARGEN-IAM-ST). Se compara- ron las características clínicas, tratamientos y evolución de los AM y los adultos jóvenes. Resultados: Se incluyeron 6676 pacientes, de los cuales 3626 (54,3%) eran AM. Los AM fueron más frecuentemente mujeres (37,6% vs. 31,4%, p <0,001), hipertensos (67,8% vs. 47%, p <0,001), diabéticos (26,1% vs. 19,9%, p <0,001), dislipidémicos (45,4% vs. 37%, p <0,001), y tuvieron más antecedentes coronarios (16% vs. 10,3%, p <0,001). El tiempo a la consulta de los AM fue mayor (120 min vs. 105 min, p <0,001) con similar tiempo total de isquemia (314 min vs. 310 min, p = 0,33). Recibi- eron menos tratamiento de reperfusión (89,9% vs. 88,6%, p = 0,04) y más angioplastia primaria (91 % vs. 87,4%, p <0,001). Tuvieron más insuficiencia cardíaca (27,3% vs. 18,5%, p <0,001), similar incidencia de sangrado (3,7 vs. 3,1%, p = 0,33) y una mortalidad significativamente mayor (11,4% vs. 5,5%, p <0,001). Ser AM fue predictor independiente de mortalidad. Conclusiones: Más de la mitad de los IAM en nuestro país ocurren en AM. Los pacientes mayores tienen menor probabilidad de recibir reperfusión, más insuficiencia cardíaca y el doble de la mortalidad que los pacientes menores de 60 años.

ABSTRACT Background: The World Health Organization (WHO) defines an Older Adult (OA) as any individual aged 60 or older. It is known that mortality due to acute myocardial infarction (AMI) increases with age, but age thresholds higher than those proposed by the WHO have been consistently used; therefore, describing the characteristics and in-hospital progress of this subgroup of patients, in accordance with the WHO definition, becomes relevant. Objectives: 1) To know the prevalence of OA with acute ST-elevation myocardial infarction (STEMI) in Argentina according to the WHO, and 2) to compare their characteristics, reperfusion treatments, and mortality against those in young adults. Methods: Patients included in the National Registry of ST- Elevation Myocardial Infarction (Registro Nacional de Infarto con Elevación del ST, ARGEN-IAM-ST) were analyzed. Clinical features, therapies, and progress were compared in OA versus young adults. Results: A total of 6676 patients were enrolled, 3626 of which (54.3%) were OA. OA were mostly female (37.6% vs 31.4%, p <0.001), had hypertension (67.8% vs 47%, p <0.001), diabetes (26.1% vs 19.9%, p <0.001), dyslipidemia (45.4% vs 37%, p <0.001), and a longer coronary artery disease history (16% vs 10.3%, p < 0.001). The time to consultation in OA was longer (120 min vs 105 min, p <0.001), with a similar total ischemic time (314 min vs 310 min, p = 0.33). They received less reperfu- sion treatment (89.9% vs 88.6%, p = 0.04) and more primary angioplasty (91% vs 87.4%, p <0.001). Heart failure was more common in OAs (27.3% vs 18.5%, p <0.001), with a similar bleeding incidence (3.7% vs 3.1%, p = 0.33), and significantly higher mortality (11.4% vs 5.5%, p<0.001). Being an OA was an independent mortality predictor. Conclusions: More than half the cases of AMI in our country occur in OA. Older patients are less likely to receive reperfusion, more likely to have heart failure, and show twice the rate of mortality as compared to patients under 60.

Estado inflamatorio en el infarto agudo de miocardio, su impacto en el remodelado ventricular y nuevas dianas terapéuticas / Inflammation in acute myocardial infarction, impact on ventricular remodeling, and new therapeutic targets

RESUMEN La cardiopatía isquémica es la causa más frecuente de insuficiencia cardíaca, con una alta incidencia de esta a pesar de la revascularización precoz y la modulación neurohormonal. En el contexto del infarto agudo de miocardio los cardiomiocitos necrosados inducen la activación del sistema inmune innato, con aumento de la concentración de células inflamatorias que ayudan a eliminar las células muertas, e iniciar una respuesta correctiva que permite la formación adecuada de tejido cicatrizal.La prolongación o expansión de la respuesta inflamatoria posterior al infarto contribuye al remodelado adverso ventricular y al desarrollo de insuficiencia cardíaca.Entender los mecanismos inflamatorios que se desarrollan producto del infarto, y su impacto en el remodelado adverso que aumenta el número de eventos cardiovasculares mayores, permite comprender a la inflamación como un objetivo terapéutico.

ABSTRACT Ischemic heart disease is the most common cause of heart failure, with a high incidence of heart failure despite early revascularization and neurohormonal modulation.In the acute myocardial infarction setting, necrotized cardiomyocytes induce activation of the innate immune system, increasing the levels of inflammatory cells to help remove dead cells and initiate a corrective response, which allows for proper scar tissue formation.A prolonged or expanded inflammatory response after infarction contributes to adverse ventricular remodeling and development of heart failure.Understanding the inflammatory mechanisms that emerge as a result of myocardial infarction and their impact on adverse remodeling that leads to an increased.

Infarto pulmonar: signos que no debemos dejar pasar en TC de tórax sin contraste / Pulmonary infarction: the signs that we must not miss in chest CT without contrast

Resumen El infarto pulmonar (IP) resulta de la oclusión de las arterias pulmonares distales que generan isquemia, hemorragia y finalmente necrosis del parénquima pulmonar, siendo la causa más frecuente la embolia pulmonar (EP). El diagnóstico oportuno de IP permite el inicio precoz del tratamiento y el respectivo manejo de sostén, disminuyendo así la morbimortalidad asociada. El objetivo de esta revisión es remarcar la importancia de identificar aquellos signos, que en la tomografía computada (TC) sin contraste son altamente sensibles y específicos para el diagnóstico de IP. La TC de alta resolución constituye el método que más información aporta, pudiendo observar signos clásicos de IP como la opacidad en forma de cuña, opacidad con radiolucencia central y el signo del vaso nutricio; así como signos con alto valor predictivo negativo para IP, como la opacidad consolidativa con broncograma aéreo, sugestivo de otras patologías, ya sean infecciosas o tumorales.

Abstract Pulmonary infarction (PI) results from occlusion of the distal pulmonary arteries leading to ischemia, hemorrhage, and necrosis of the pulmonary parenchyma. The most common cause of pulmonary infarction is pulmonary embolism (PE). Early diagnosis of PI allows early initiation of treatment and supportive care, thus reducing the associated morbidity and mortality. This review aims to highlight the importance of identifying signs that are highly sensitive and specific for the diagnosis of PE even without IV contrast. High-resolution computed tomography (CT) is the method that provides the most information, as it observes classic signs of PI such as wedge-shaped opacity, central lucencies in peripheral consolidation, and the feeding vessel sign, as well as signs with high negative predictive value such as consolidating opacity with air bronchogram that are suggestive of other pathologies, whether infectious or tumoural.