Diagnostic and Prognostic Value of miRNAs after Coronary Artery Bypass Grafting: A Review

Acute aortic dissection after proximal anastomoses of vein grafts: A case report

INTRODUCTION AND IMPORTANCE

Coronary artery bypass grafting (CABG) is a critical surgical procedure for treating multi-vessel coronary artery disease (CAD) and significant coronary artery stenosis. Although widely accepted, CABG carries notable morbidity and mortality risks. Aortic dissection (AD), a rare but life-threatening complication, occurs when a rupture in the aortic wall creates a false lumen. This study describes a patient who experienced aortic dissection following on-pump CABG.

CASE PRESENTATION

A 58-year-old male with a recent lateral myocardial infarction (MI) underwent CABG involving left internal mammary artery (LIMA) grafting to the left anterior descending artery (LAD) and two great saphenous vein grafts. The patient, a smoker with no significant past medical or family history, presented two days post-surgery with severe loss of consciousness and shortness of breath. Computed tomography (CT) angiography revealed an intimal flap in the descending aorta and ascending aorta dilation. The patient was diagnosed with aortic dissection and underwent successful Bentall surgery.

CLINICAL DISCUSSION

This case highlights the critical need for early recognition of aortic dissection after CABG, as timely diagnosis and treatment are essential for survival. It emphasizes the importance of using careful surgical techniques, such as clamping during graft anastomoses, to reduce risks. Advanced imaging, like CT angiography, remains key to confirming the diagnosis and guiding prompt intervention.

CONCLUSIONS

This report underscores the risk of aortic dissection associated with CABG, particularly with tangential clamping techniques. It emphasizes the need for vigilance during surgical procedures and further research to optimize surgical approaches and improve patient outcomes.

Plasma leukocyte-derived extracellular vesicles are related to target vessel revascularization in off-pump coronary artery bypass grafting

Introduction

In multivessel coronary disease, interventional therapy is recommended to improve symptoms and survival. Inflammatory activation is postulated as one of the coronary atherosclerosis progression risk factors and prognostic indicators of surgical intervention. Counts of plasma extracellular vesicles (EVs) derived from erythrocytes, leukocytes, and platelets are elevated in patients with inflammatory diseases, including atherosclerosis-based cardiovascular diseases.

Aim

We aimed to estimate the association between blood flow measurements in coronary artery bypass grafts and EV plasma count changes in patients undergoing surgical coronary revascularization.

Material and methods

Forty-four consecutive patients who underwent surgical off-pump revascularization (33 males, 75%) in the median (Q1-Q3) age of 65 (58-69) were included. The blood flow in the implanted coronary artery bypass grafts was measured intraoperatively. EV counts were measured at baseline (hospital admission) and on the 1st and 3rd postoperative days. The numbers of EVs from erythrocytes (CD235+), leukocytes (CD45+) and platelets (CD61+) were measured using flow cytometry with fluorescently labeled antibodies against specific antigens exposed on the EVs.

Results

The numbers of leukocyte-derived EVs were lower in patients who received a LIMA-LAD graft (p = 0.020). The total EV plasma count changes were found significant for RIMA-LAD grafting (p = 0.028) and LIMA-LAD (p = 0.015) in arterial and arterio-venous grafting, respectively.

Conclusions

Surgical revascularizations affect EV plasma count, including significantly lower postoperative values of leukocyte-derived EVs related to left descending artery grafting.

Potentially Risk Factors for New Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study

Objective

Our study evaluated the risk factors for new postoperative atrial fibrillation (POAF) by analyzing the data collected from patients who underwent first coronary artery bypass grafting (CABG).

Methods

Our study retrospectively collected data from January 2021 to December 2023 at Changzhi People's Hospital. The perioperative period data were collected, and logistic regression was used to analyze the independent predictors of the occurrence of POAF after CABG and the related predictive values of risk factors were analyzed by using the subjects' work characteristic curve (ROC).

Results

A total of 169 patients were included, and there are 45 patients in the POAF group, with an incidence of 26.6%, and 124 in the non-POAF group. The POAF group was significantly higher than the non-POAF group in terms of age (69.2±8.8 years vs 62.3±9.3 years) and preoperative LAD (42.7±7.2mm vs 36.8±5.5mm), and the difference was significant (P<0.05). Preoperative HDL-C in the POAF group were lower than non-POAF group (1.0±0.5 mmol/l vs 1.4±0.7 mmol/l, P<0.05). The logistic regression analysis revealed a significant correlation between age, LAD, HDL-C and the occurrence of POAF (P<0.05). According to the ROC curve analysis, age >64.5 years, LAD >41mm, and HDL-C <0.9 mmol/l were the cut-off values for predicting the occurrence of POAF (AUC1=0.733; AUC2=0.741; AUC3=0.647, P < 0.05). The combined age + LAD + HDL-C (AUC = 0.755; P < 0.05) had a higher diagnostic value and high sensitivity.

Conclusion

The age, LAD, and HDL-C are independent risk factors for the POAF after CABG, and clinicians should assess these risk factors as much as possible when managing patients in the perioperative period and make corresponding measures to prevent the development of POAF.

Increased Plasma Concentrations of Extracellular Vesicles Are Associated with Pro-Inflammatory and Pro-Thrombotic Characteristics of Left and Right Ventricle Mechanical Support Devices

Mechanical circulatory support (MCS) allows for functional left and right heart ventricle replacement. MCS induces a systemic inflammatory reaction and prothrombotic state leading to an increased risk of thrombus formation. The extracellular vesicles (EVs) are nanoparticles released from active/injured cells characterized by prothrombotic properties. Simple inflammatory parameters from whole blood count analysis have established a clinical role in everyday practice to describe immune-inflammatory activation. We hypothesized that increased plasma concentrations of EVs might be associated with the proinflammatory and pro-thrombotic characteristics of left ventricle assist device (LVAD) and right ventricle assist device (RVAD) devices. We presented a pilot study showing the concentration of peripheral blood serum, right and left ventricle mechanical assist device extracellular concentration in relation to thrombotic complication in patients treated with a biventricular pulsatile assist device (BIVAD). The observation was based on 12 replacements of pulsatile pumps during 175 days of observation. The proinflammatory characteristics of LVAD were noted. The proinflammatory and procoagulant activation by RVAD was observed. The results may provide possible explanations for the worse results of right-sided mechanical supports observed in clinical practice.

Analysis of infiltrated immune cells in left atriums from patients with atrial fibrillation and identification of circRNA biomarkers for postoperative atrial fibrillation

Background: Atrial fibrillation (AF) increases the risk of stroke and heart failure. Postoperative AF (POAF) increases the risk of mortality after cardiac surgery. This study aims to explore mechanisms underlying AF, analyze infiltration of immune cells in left atrium (LA) from patients with AF, and identify potential circular RNA (circRNA) biomarkers for POAF. Methods: Raw data of GSE797689, GSE115574, and GSE97455 were downloaded and processed. AF-related gene co-expression network was constructed using weighted gene correlation network analysis and enrichment analysis of genes in relevant module was conducted. Gene set enrichment analysis (GSEA) and gene set variation analysis (GSVA) were applied to investigate pathways significantly enriched in AF group. Infiltration of immune cells was analyzed using single-sample GSEA. Differentially expressed genes (DEGs) between patients with or without AF were identified and competing endogenous RNA (ceRNA) networks of DEGs were constructed. To screen biomarkers for POAF, differentially expressed circRNAs (DEcircRNAs) between patients with or without POAF were identified. Intersection between DEcircRNAs and circRNAs in ceRNA networks of DEGs were extracted and circRNAs in the intersection were further screened using support vector machine, random forest, and neural network to identify biomarkers for POAF. Results: Three modules were found to be relevant with AF and enrichment analysis indicated that genes in these modules were enriched in synthesis of extracellular matrix and inflammatory response. The results of GSEA and GSVA suggested that inflammatory response-related pathways were significantly enriched in AF group. Immune cells like macrophages, mast cells, and neutrophils were significantly infiltrated in LA tissues from patients with AF. The expression levels of immune genes such as CHGB, HLA-DRA, LYZ, IGKV1-17 and TYROBP were significantly upregulated in patients with AF, which were correlated with infiltration of immune cells. ceRNA networks of DEGs were constructed and has_circ_0006314 and hsa_circ_0055387 were found to have potential predictive values for POAF. Conclusion: Synthesis of extracellular matrix and inflammatory response were main processes involved in development and progression of AF. Infiltration of immune cells was significantly different between patients with or without AF. Has_circ_0006314 and hsa_circ_0055387 were found to have potential predictive values for POAF.

MicroRNA-126-3p/5p and Aortic Stiffness in Patients with Turner Syndrome

Background: Turner Syndrome (TS) is a relatively rare X-chromosomal disease with increased cardiovascular morbidity and mortality. This study aimed to identify whether the circulating miR-126-3p/5p are involved in the pathophysiology of vascular dysfunction in TS. Methods: Using the RT-qPCR, the abundance levels of miR-126-3p and miR-126-5p were determined in 33 TS patients and 33 age-matched healthy volunteers (HVs). Vascular screening, including the assessment of blood pressure, pulse wave velocity, augmentation index, aortic deformation, arterial distensibility, and arterial elastance, was conducted in TS patients and HVs. Results: The abundance levels of miR-126-3p and miR-126-5p were significantly higher in TS patients compared to HVs (p < 0.0001). Within the TS cohort, miR-126-3p/5p correlated significantly with aortic deformation (r = 0.47, p = 0.01; r = 0.48, p < 0.01) and arterial distensibility (r = 0.55, p < 0.01; r = 0.48, p < 0.01). In addition, a significant negative correlation was demonstrated between miR-126-3p and arterial elastance (r = −0.48, p = 0.01). The receiver operating characteristic analysis showed that miR-126-3p and miR-126-5p separated the tested groups with high sensitivity and specificity. Conclusions: The abundance levels of miR-126-3p and miR-126-5p were significantly higher in TS patients compared to HVs. Within the TS cohort, a lower abundance level of miR-126-3p and miR-126-5p was linked with a significantly higher aortic stiffness.