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Jiang L, Xiong W, Yang Y, Qian J. Insight into Cardioprotective Effects and Mechanisms of Dexmedetomidine. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07579-9. [PMID: 38869744 DOI: 10.1007/s10557-024-07579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Cardiovascular disease remains the leading cause of death worldwide. Dexmedetomidine is a highly selective α2 adrenergic receptor agonist with sedative, analgesic, anxiolytic, and sympatholytic properties, and several studies have shown its possible protective effects in cardiac injury. The aim of this review is to further elucidate the underlying cardioprotective mechanisms of dexmedetomidine, thus suggesting its potential in the clinical management of cardiac injury. RESULTS AND CONCLUSION Our review summarizes the findings related to the involvement of dexmedetomidine in cardiac injury and discusses the results in the light of different mechanisms. We found that numerous mechanisms may contribute to the cardioprotective effects of dexmedetomidine, including the regulation of programmed cell death, autophagy and fibrosis, alleviation of inflammatory response, endothelial dysfunction and microcirculatory derangements, improvement of mitochondrial dysregulation, hemodynamics, and arrhythmias. Dexmedetomidine may play a promising and beneficial role in the treatment of cardiovascular disease.
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Affiliation(s)
- Leyu Jiang
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Xiong
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqiao Yang
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinqiao Qian
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China.
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2
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Jiang Y, Liu J, Peng W, Wang A, Guo L, Xu Z. Comparison of invasive blood pressure monitoring versus normal non-invasive blood pressure monitoring in ST-elevation myocardial infarction patients with percutaneous coronary intervention. Injury 2022; 53:1108-1113. [PMID: 34973831 DOI: 10.1016/j.injury.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypotension post percutaneous coronary intervention (PCI) causes stent thrombosis and reduced coronary perfusion, which aggravate myocardial ischemia and lead to patient death. Therefore, the accuracy and timeliness of blood pressure monitoring (BPM) are crucial for the nursing of patients post PCI. However, it is still controversial whether invasive blood pressure monitoring (IBPM) or non-invasive blood pressure monitoring (NIBPM) should be used for patients post PCI, and the magnitude of their assistance for patients' recovery remains unclear. METHODS A randomized controlled trial was performed in this study. 126 ST-segment elevation myocardial infarction (STEMI) patients post PCI were recruited and randomly divided into two groups (NIBPM group n = 63; IBPM group n = 63). RESULTS Clinical characteristics and physiological outcomes of participants received different BPM methods were collected and analyzed to compare the effects of these two methods on the nursing of PCI patients. Compared to NIBPM group, IBPM assisted to shorten the time of myocardial ischemia, promote coronary reperfusion, reduce the occurrence of cardiovascular disease and other complications, and ultimately reduce the mortality of patients post PCI. CONCLUSION The application of IBPM contributed to reduce the occurrence of complications, shorten the time of vascular reperfusion, and guide treatment of clinicians in time.
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Affiliation(s)
- Yang Jiang
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Junying Liu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Wanzhong Peng
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Aili Wang
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Lina Guo
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China
| | - Zesheng Xu
- Department 2 of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Cangzhou 061000, Hebei, China.
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Millo L, McKenzie A, De la Paz A, Zhou C, Yeung M, Stouffer GA. Usefulness of a Novel Risk Score to Predict In-Hospital Mortality in Patients ≥ 60 Years of Age with ST Elevation Myocardial Infarction. Am J Cardiol 2021; 154:1-6. [PMID: 34261591 DOI: 10.1016/j.amjcard.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
Numerous algorithms are available to predict short-term mortality in ST elevation myocardial infarction (STEMI) but none are focused on elderly patients or include invasive hemodynamics. A simplified risk score (LASH score) including left ventricular end diastolic pressure > 20 mm Hg, age > 75 years, systolic blood pressure < 100 mm Hg and heart rate > 100 bpm was tested in a retrospective, single-center study of 346 patients ≥ 60 years old who underwent primary percutaneous coronary intervention (PPCI). The median age was 70 years [IQR: 64, 79], 60.1% were men, and 77.8% identified as White. In-hospital all-cause mortality was 10.1%. Patients with a LASH score ≥ 3 (n = 34) had an in-hospital mortality rate of 44.1% compared to 6.4% for LASH score ≤ 2 (p < 0.0001). The odds ratio for in-hospital mortality for patients with LASH score ≥ 3 was 13.2 (95% CI 5.3-33.1) compared to patients with a LASH score ≤ 2 when adjusted for sex, cardiac arrest, heart failure, and prior cerebrovascular event. The LASH score had an area under the ROC curve for predicting in-hospital mortality of 0.795 [CI 0.716-0.872], as compared to TIMI-STEMI (0.881, CI 0.829-0.931; p = 0.01), GRACE (0.849, CI 0.778-0.920; p = 0.19), shock index (0.769, CI 0.667-0.871; p = 0.51) and modified shock index (0.765, CI 0.716-0.873; p = 0.48). In summary, a simplified, easy to calculate risk score that incorporates age and invasive hemodynamics predicts in-hospital mortality in patients ≥ 60 years old undergoing PPCI for STEMI.
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Affiliation(s)
- Lorena Millo
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alexander McKenzie
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Andrew De la Paz
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Cynthia Zhou
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael Yeung
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - George A Stouffer
- Division of Cardiology and McAllister Heart Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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Khan AA, Davies AJ, Whitehead NJ, McGee M, Al-Omary MS, Baker D, Bhagwandeen R, Renner I, Majeed T, Hatton R, Collins NJ, Attia J, Boyle AJ. Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:758-763. [DOI: 10.1177/2048872618819657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Elevated left ventricular end diastolic pressure (LVEDP) is an independent predictor of mortality and heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Whether lowering elevated LVEDP improves outcomes remains unknown.
Methods:
This non-randomized, single blinded study with prospective enrolment and sequential group allocation recruited patients undergoing primary percutaneous coronary intervention for STEMI with LVEDP ⩾ 20 mmHg measured immediately after primary percutaneous coronary intervention. The intervention arm (n=10) received furosemide 40 mg intravenous bolus plus escalating doses of glyceryl trinitrate (100 µg per min to a maximum of 1000 µg) during simultaneous measurement of LVEDP. The control group (n=10) received corresponding normal saline boluses with simultaneous measurement of LVEDP (10 readings over 10 min). Efficacy endpoints were final LVEDP achieved, and the dose of glyceryl trinitrate needed to reduce LVEDP by ⩾ 20%. Safety endpoint was symptomatic hypotension (systolic blood pressure < 90 mmHg).
Results:
From 1 April 2017 to 23 August 2017 we enrolled 20 patients (age: 64±9 years, males: 60%, n=12, anterior STEMI: 65%, n=13). The mean LVEDP for the whole cohort (n=20) was 29±4 mmHg (intervention group: 28±3 mmHg vs. control group: 31±5 mmHg; p=0.1). The LVEDP dropped from 28±3 to 16±2 mmHg in the glyceryl trinitrate + furosemide group (p <0.01) but remained unchanged in the control group. The median dose of glyceryl trinitrate required to produce ⩾ 20% reduction in LVEDP in the intervention group was 200 µg (range: 100–800). One patient experienced asymptomatic decline in systolic blood pressure to below 90 mmHg. There was no correlation between LVEDP and left ventricular ejection fraction.
Conclusion:
The administration of glyceryl trinitrate plus furosemide in patients with elevated LVEDP following primary percutaneous coronary intervention for STEMI safely reduces LVEDP.
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Affiliation(s)
- Arshad A Khan
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | | | | | | | - Mohammed S Al-Omary
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
| | | | | | | | - Tazeen Majeed
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | | | - Nicholas J Collins
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - John Attia
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew J Boyle
- John Hunter Hospital, Newcastle, Australia
- The University of Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
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The association of left ventricular end-diastolic pressure with global longitudinal strain and scintigraphic infarct size in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2020; 37:359-366. [PMID: 32761496 DOI: 10.1007/s10554-020-01945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Left ventricular end-diastolic pressure (LVEDP) is an independent predictor for prognosis in ST-elevation myocardial infarction (STEMI) patients. We aimed to investigate the relationship of admission LVEDP measured after a successful primary percutaneous coronary intervention (pPCI) with scintigraphic infarct size (IS) and global longitudinal strain (GLS), a strong predictor of IS, in STEMI patients. A total of 62 consecutive patients with STEMI were enrolled in the study. LVEDP measurements were performed after pPCI in patients who had TIMI-3 flow. Echocardiography was performed 24 h after pPCI and repeated 3 months later. GLS was calculated as an average peak strain from the 3 apical projections. IS was evaluated at the third month by technetium 99m sestamibi. The mean age was 56 ± 8 years in the study population. The mean LVEDP was found 19.4 ± 4.4 mmHg. Median IS was 4% (0-11.7 IQR).The mean GLS at the 24th hour and the third month were found to be - 15.4 ± 2.8 and - 16.7 ± 2.5 respectively. There was a moderate negative correlation between LVEDP and GLS (24th-hour p < 0.001 r = - 0.485 and third-month p < 0.001 r = - 0.489). LVEDP had a moderate positive correlation with scintigraphic IS (p < 0.001 r = 0.545). In the multivariable model, we found that LVEDP was significantly associated with scintigraphic IS (β coefficient = 0.570, p = 0.008) but was not associated with the 24th hour (β coefficient = 0.092, p = 0.171) and third month GLS (β coefficient = 0.037, p = 0.531). This study demonstrated that there was a statistically significant relationship between LVEDP and scintigraphic IS, and IS was increased with high LVEDP values. However, there was not a relationship between LVEDP and GLS.
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Ndrepepa G, Cassese S, Hashorva D, Kufner S, Xhepa E, Hasimi E, Fusaro M, Laugwitz K, Schunkert H, Kastrati A. Relationship of left ventricular end‐diastolic pressure with extent of myocardial ischemia, myocardial salvage and long‐term outcome in patients with ST‐segment elevation myocardial infarction. Catheter Cardiovasc Interv 2019; 93:901-909. [DOI: 10.1002/ccd.28098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Salvatore Cassese
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Desard Hashorva
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Sebastian Kufner
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Erion Xhepa
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Endri Hasimi
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Massimiliano Fusaro
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
| | - Karl‐Ludwig Laugwitz
- 1. Medizinische Klinik, Klinikum rechts der IsarTechnische Universität Munich Germany
- DZHK (German Centre for Cardiovascular Research)partner site Munich Heart Alliance Munich Germany
| | - Heribert Schunkert
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
- DZHK (German Centre for Cardiovascular Research)partner site Munich Heart Alliance Munich Germany
| | - Adnan Kastrati
- Department of Adult Cardiology, Deutsches Herzzentrum MünchenTechnische Universität Munich Germany
- DZHK (German Centre for Cardiovascular Research)partner site Munich Heart Alliance Munich Germany
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