Valor prognóstico do escore SYNTAX residual nos desfechos clínicos intra- hospitalares e de acompanhamento em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST submetidos à estratégia farmacoinvasiva / Prognostic value of residual SYNTAX score on in-hospital and follow-up clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive strategy

Introdução: A doença arterial coronariana multiarterial é um desafio na prática clínica. Uma abordagem individualizada deve considerar não apenas as características do paciente, mas também um enfoque multidisciplinar, com o Heart Team. Diversos escores angiográficos foram propostos com o objetivo de quantificar o risco associado à doença arterial coronariana multiarterial. O escore SYNTAX residual foi proposto como um método para caracterizar e quantificar a doença coronariana residual, de forma sistemática, após intervenção coronária percutânea. Existem poucos dados na literatura que correlacionam o escore SYNTAX residual em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST submetidos a uma estratégia farmacoinvasiva. O objetivo deste estudo foi avaliar o escore SYNTAX e o escore SYNTAX residual como preditores de desfechos intra-hospitalares e de médio prazo (180 a 380 dias), em pacientes com doença coronária multiarterial no contexto de infarto do miocárdio com supradesnivelamento do segmento ST, após terapia fibrinolítica bem-sucedida. Métodos: Em um estudo transversal, analítico e prospectivo, avaliamos o escore SYNTAX residual como preditor de desfechos intra-hospitalares e de médio prazo (6 meses a 1 ano), em pacientes com doença arterial coronariana multiarterial, no contexto de infarto do miocárdio com supradesnivelamento do segmento ST após estratégia farmacoinvasiva. Resultados: Entre agosto de 2019 e dezembro de 2020, foram analisados 108 pacientes com infarto do miocárdio com supradesnivelamento do segmento ST após fibrinólise, com critérios de reperfusão. O escore SYNTAX médio foi 13,98 (±4,87) e o escore SYNTAX residual médio foi 7,56 (±4,47). O escore SYNTAX residual elevado foi associado à nefropatia induzida por contraste e evento cardíaco adverso maior. Também foi um preditor independente de evento cardíaco adverso maior, com risco aumentado 9,69 vezes (p=0,0274). Conclusão: O escore SYNTAX residual elevado confere pior prognóstico em pacientes com infarto do miocárdio com elevação do segmento ST após estratégia farmacoinvasiva.

Background: Multivessel coronary artery disease is a challenge in clinical practice. An individualized approach should consider not only the patient characteristics, but also a multidisciplinary approach, together with the Heart Team. Multiple angiographic scores have been proposed with the aim of quantifying the risk associated with multivessel coronary artery disease. Residual SYNTAX score has been proposed as a method to systematically characterize and quantify residual coronary disease after percutaneous coronary intervention. There are few data in the literature correlating the residual SYNTAX score in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive strategy. The objective of this study was to evaluate the SYNTAX score and residual SYNTAX score as predictors of in-hospital and medium-term outcomes (180 to 380 days) in patients with multivessel coronary artery disease in the setting of ST-segment elevation myocardial infarction, after successful fibrinolytic therapy. Methods: In a cross-sectional, analytical, and prospective study, we evaluated residual SYNTAX score as predictor of in-hospital and medium-term outcomes (6 months to 1 year), in patients with multivessel coronary artery disease, in the setting of ST-segment elevation myocardial infarction after pharmacoinvasive strategy. Results: Between August 2019 and December 2020, 108 patients with ST-segment elevation myocardial infarction after fibrinolysis, with reperfusion criteria, were analyzed. The mean SYNTAX score was 13.98 (±4.87) and the mean residual SYNTAX score was 7.56 (±4.47). High residual SYNTAX score was associated with contrast-induced nephropathy and major adverse cardiac event. It was also an independent predictor of major adverse cardiac event with a 9.69-fold increased risk (p=0.0274). Conclusion: High residual SYNTAX score confers worse prognosis in patients with ST-segment elevation myocardial infarction after pharmacoinvasive strategy.

Salvianolic acid A inhibits platelet and neutrophil activation / 中国药理学通报

Aim To explore the effeets of Salvianolie aeirl A (SAA) on platelet recruitment, activation and neutrophils in heart of myocardial infarction ( Ml ) mice.Methods C57BL/6 mice were randomly divid¬ed into: Sham operation group.Ml model group, SAA (5, 10 mg • kg 1 ) group, tirofiban (Tirofiban, 0.87 mg • kg ' ) group, using tail vein injection for 3 d.Echocardiography and HE staining were used to detect mouse heart function and infarct area; 1HC, FCS, ELISA, Western blot and other methods were used to explore the inhibitory effect of SAA on platelet and neutrophil activation.Results Compared with Ml group, SAA could improve the cardiac function and cardiac physiology changes of Ml mice, reduce the ex¬pression of CD42c in myocardial tissue and CD62p in peripheral blood without affecting tail bleeding time, reduce ADP-induced platelet activation and increase p- VASP/VASP ratio, reduce the ratio of p-PI3K/PI3K and p-AKT/AKT, reduce the expression of CD45, Ly6G, CXCL1 and CXCL2 in myocardial tissue, re¬duce the expression of complement component C3aR in myocardial tissue, and reduce C3a-induced NE and MPO, MMP9, LF level.Conclusions SAA has an anti-platelet activation effect by inhibiting the PI3K/ AKT and VASP pathways and an anti-neutrophil acti¬vation effect by inhibiting the expression of C3aR and C3a.

Estudio Transversal: Riesgo Cardiovascular en Diabetes Mellitus II según Score UKPDS en pacientes del Hospital José Carrasco Arteaga / Cross-Sectional Study: Cardiovascular Risk in Diabetes Mellitus II using UKPDS Score in Hospital José Carrasco Arteaga patients

INTRODUCCIÓN: La Diabetes Mellitus Tipo 2 (DM2) es una enfermedad de gran impacto sanitarionitario y socioeconómico. Las complicaciones cardiovasculares son su principal causa de muerte, por este motivo es de gran importancia la aplicación de estrategias de prevención. El objetivo de este estudio fue determinar el Riesgo Cardiovascular según el Score UKPDS en pacientes con Diabetes Mellitus Tipo 2 atendidos en del Hospital José Carrasco Arteaga de Cuenca-Ecuador, durante el periodo noviembre 2018 a agosto 2019. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo, de corte transversal, con una muestra de 118 pacientes con diagnóstico de DM2 atendidos en el Hospital José Carrasco Arteaga, entre noviembre 2018 a agosto 2019. Se revisaron los registros clínicos, se recopilo la información en un formulario con todas las variables del Score UKPDS. La estimación del Riesgo Cardiovascular (RCV) se llevó a cabo con ayuda de la Calculadora Risk Engine versión 2.0 del Score UKPDS. RESULTADOS: En la población de estudio predominó el sexo femenino. La edad se encontró en un rango de 32 a 95 años, el grupo etario de mayor frecuencia fue el de 55 a 59 años con el 16.1%. En el 40% de la muestra la duración de la enfermedad fue de >10 años. El 42.4% (n=50) presentó valores ≥130mmHg de PAS. El 75.4% de la muestra tenían un mal control glucémico, con hemoglobina glicosilada mayor al rango normal para el grupo de edad. El RCV estimado a 5 años se mantuvo dentro de "Riesgo Bajo" para la mayoría de la muestra; mientras que a los 10 años se encontró que aumenta el riesgo sobre todo para ECV no Fatal (Riesgo alto: 21.25%) y para IAM Fatal (6.8%) y no Fatal (6.8%). CONCLUSIÓN: La mayoría de pacientes tenían más de 10 años de evolución de DMII. Más de la mitad de la muestra tenían un control glicémico inadecuado. El riesgo cardiovascular a los 5 años fue "bajo" para la mayoría de la población, tanto para IAM como para ECV. El riesgo cardiovascular a los 10 años fue ligeramente mayor para todas las entidades, sobre todo aumenta para ECV no fatal, a "riesgo muy alto" del 21.2%, el riesgo de IAM también aumenta a riesgo muy alto del 6.8%.

BACKGROUND: Type 2 Diabetes Mellitus (DM2) is a disease of great health and socioeconomic impact. Cardiovascular complications are the main cause of death in diabetic patients, for this reason the application of prevention strategies is important. The aim of the research was to determine the cardiovascular risk according to UKPDS Score in patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, Cuenca-Ecuador, from November 2918 to August 2019. METHODS: A descriptive, cross-sectional study was conducted with a sample of 118 patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, between November 2018 and August 2019. Clinical records were reviewed, information was collected on a form with all the variables of the UKPDS Score. Cardiovascular Risk Estimation (RCV) was carried out with the Risk Engine Calculator version 2.0 of the UKPDS Score. RESULTS: The female sex predominated in the study population. The age range went from 32 to 95 years old, the most frequent range of age was 55 to 59 years old (16.1%). The disease duration in 40% of the population was higher than 10 years. 42.4 %(n=50) presented SBP values ≥130mmHg. 75.4% of the sample had poor glycemic control, with glycosylated hemoglobin levels higher than the normal range for each age group. The estimated 5-year CVR was low for most of the sample; while the 10 year CVR increased, especially for non-fatal CVD(high risk:21.25%) and for fatal (6.8%) and non-fatal(6.8%) AMI. CONCLUSION: Most of the patients had more than 10 years with DMII diagnosis. More than half of the sample had inadequate glycemic control. The CVR at 5 years was "low" for the majority of the population, both for AMI and CVD. The cardiovascular risk at 10 years was slightly higher for all entities, especially it increases for non-fatal CVD, to a "very high risk" of 21.2%, and the risk of AMI also increases to a "very high risk" of 6.8%.

Isquemia e infarto perioperatorio / Ischemia and perioperative infarction

Abstract Introduction: Perioperative medicine has provided anesthetists with a proactive role in the prevention of perioperative compli cations, in particular cardiovascular events such as myocardial injury after non-cardiac surgery. Objective: Using cardiovascular risk concepts, pre-operative assessment for non-cardiac surgery, optimization of the hemo-dynamic status, determination of differences between elective and urgent patients, monitoring, close follow-up after surgery, and measurements of ultrasensitive troponin in the first 48 hours postoperatively, anesthetists are now able to identify and address early clinical manifestations of perioperative ischemia and myocardial infarction (MI) in patients at risk. Materials and methods: Narrative review: Queries in various databases on perioperative ischemia and non-fatal infarction in Pubmed, Science Direct, and Ovid. Results: The analysis of cardiac troponin levels is of the utmost importance in the prognosis of perioperative MI. Diagnosis can be made earlier, and it has been shown that the majority of these perioperative events have their onset within the first 48 hours of the postoperative period, when the physiological stress is highest in patients taken to non-cardiac surgery.

Resumen Introducción: La medicina perioperatoria ha permitido que el anestesiólogo asuma un rol proactivo en la prevención de las complicaciones perioperatorias, especialmente las cardiovasculares, entre ellas la lesión miocárdica que ocurre después de cirugía no cardiaca (MINS- Myocardial injury after noncardiac surgery). Objetivo: A partir de conceptos de riesgo cardiovascular, evaluación preoperatoria para cirugía no cardiaca, optimización del estado hemodinámico, establecimiento de diferencias entre pacientes programados y urgentes, monitoria, vigilancia estrecha de la evolución y toma de niveles de troponina ultrasensible en las primeras 48 horas del posoperatorio, el anestesiólogo ha logrado identificar e intervenir de manera precoz los cuadros clínicos relacionados con isquemia e infarto de miocardio perioperatorio en los pacientes de riesgo. Materiales y métodos: Revisión narrativa. Consulta de diferentes bases de datos sobre isquemia e infarto no fatal perioperatorio, en Pubmed, Science Direct y Ovid. Resultados: El análisis de los niveles de troponina cardiaca tiene gran importancia en el pronóstico del infarto de miocardio perioperatorio. El diagnóstico se hace más temprano y se ha demostrado que la mayoría de estos eventos perioperatorios inician en las primeras 48 horas del postoperatorio, momento del mayor estrés fisiológico en el paciente de cirugía no cardiaca.

Effect of Hedgehog pathway on myocardial infarction and hypoxic-ischemic cardiomyocytes / 中国药理学通报

Aim To investigate the effect of Sonic Hedgehog on normal hearts and hypoxic-ischemic myo-cardial cells. Methods A method for left anterior de-scending artery ( LAD ) ligation was employed to con-struct the myocardial infarction model, and ultrasonic cardiogram was used for identification. Western blot and immunofluorescence staining were used to detect expressions of Shh, Ptch-1, Smo and Gli-1 in H9C2 cells and H2 O2-induced H9C2 cells, and that in 12 ca-ses of myocardial infarction tissues and 9 cases of nor-mal myocardium, respectively. Agonist and antagonist of Shh pathway were adminstered in the hypoxic-ische-mic myocardial H2 O2-induced H9C2 cell model, and once again expressions and strength of Shh, Ptch-1, Smo, Gli-1 were detected. Results Shh and Gli-1 were not expressed in normal hearts, but expressed in hearts with myocardial infarction;Ptch-1 and Smo were expressed in both normal hearts and hearts with myo-cardial infarction. Under the action of agonist, expres-sions of Shh and Gli-1 increased in the hypoxic-ische-mic H9C2 cell model. Similarly, Shh and Gli-1 were not expressed in normal H9C2 cells, but in H2 O2-in-duced H9C2 cells, and Ptch-1 and Smo were expressed in both normal H9C2 and in H2 O2-induced H9C2 cells. Conclusion Shh signaling pathway can be acti-vated in the condition of ischemia and oxidative stress, and then it promotes the repairing of myocardial cell damage.

Preventative effects of noninvasive delayed limb ischemic preconditioning on sudden cardiac death in rats after myocardial infarction / 中国药理学通报

Aim To study the preventative effects of noninvasive delayed limb ischemic preconditioning ( NDLIP) on sudden cardiac death in rats with myocar-dial infarction. Methods Thirty healthy SD male rats weighting ( 250 ± 10 ) g were randomly divided into 3 groups:① myocardial infarction ( MI ) group: animal model of MI was established by making surgical ligation of animal LAD. ② MI plus NDLIP group: after the success of the animal model of MI, NDLIP was carried out every other day until 4th week. ③Sham group:as the negative control group, animals were taken heart LAD threading but no ligation. All rats were fed con-ventionally. At the end of 4 weeks, three groups of rats were administered with metaraminol ( 0. 2 mg · min-1 ) . ECG, drug cumulant of sudden death and death onset time were recorded. After sudden death, blood samples were withdrawn from abdominal aorta and serum was separated via centrifugation. ELISA method was used to measure serum caspase-3 , HSP70 and SOD concentration. Results While metaraminol led animal cardiac sudden death, the rats heart rate ( HR) kept declining with the increase of dosage of metaraminol during the administration period. Rat HR of MI+NDLIP group [ ( 479 ± 8 ) vs ( 416 ± 19 ) beat ·min-1 , ( 446 ± 32 ) vs ( 370 ± 20 ) beat · min-1 , (376 ± 53) vs (305 ± 29) beat·min-1, (307 ± 63) vs (244 ± 33) beat·min-1, (283 ± 45) vs (121 ± 35 ) beat · min-1 , P <0. 01 ] was markedly higher than that of MI group at 0 , 5 , 10 , 30 , 50 min before death. Compared with MI group, drugs cumulant to sudden death and death onset time of MI + NDLIP group [ ( 14. 58 ± 3. 03 ) vs ( 10. 76 ± 2. 73 ) mg, (72. 9 ± 15. 2 ) vs ( 53. 8 ± 13. 6 ) min, P <0. 01 ] were significantly increased. Compared with MI group, serum caspase-3 content of MI+NDLIP group was sig-nificantly reduced [ ( 2. 01 ± 0. 52 ) vs ( 2. 34 ± 0. 38 )μg·L-1 , P<0. 01 ]; HSP70 levels were remarkably increased [ ( 3. 01 ± 0. 58 ) vs ( 2. 70 ± 0. 43 ) μg · L-1 , P <0. 05 ]; SOD levels were significantly im-proved [(1. 99 ± 0. 65) vs (1. 70 ± 0. 58) mg·L-1, P<0. 01 ] . Conclusion NDLIP can prevent sudden cardiac death after myocardial infarction in rats, which may be mediated by reducing the myocardial cell apop-tosis, increasing protective protein expression and en-hancing antioxidant capacity.