Analysis of factors related to short-term prognosis in patients undergoing percutaneous coronary intervention for acute myocardial infarction

Honey-fried licorice in the treatment of arrhythmia: Structure elucidation and the mechanism of antiarrhythmic activity

AIM OF THE STUDY

To evaluate the therapeutic mechanism of Honey-fried licorice on arrhythmia, to explore the distribution of main components of Honey-fried licorice in vivo before and after processing, and to elucidate the active ingredient of Honey-fried licorice on arrhythmia.

MATERIALS AND METHODS

UPLC-Q-TOF/MS were used to analyze the common and different components of raw and honey-fried licorice before and after processing. Yin deficiency syndrome was established by continuous irritability and water platform sleep deprivation, and then ventricular arrhythmia model was established by injection of calcium chloride into the tail vein. Applying the electrocardiograph changes in heart rate in rats. Subsequently, ELISA and histopathological examinations were conducted to assess the therapeutic effects of honey-fried licorice on arrhythmia. Metabonomics analysis was employed to predict key regulatory pathways involved in the treatment response. Finally, RT-PCR and enzyme activity assays were utilized to verify the expression and function of key genes and proteins, providing insights into the underlying mechanisms.

RESULTS

The heart rate of rats increased after injection of Cacl2 solution into the tail vein. Honey-fried licorice has a certain improvement effect on heart injury and tachycardia, and its mechanism may be through the obvious correction effect on SOD, MDA, LDH, Na+-K+-ATPase, CaM and CAMK2 in the arrhythmia model. Under pathological conditions, Metabonomics revealed that the heart was highly exposed to glycyrrhetic acid 3-O-glucuronide, isoformononetin, araboglycyrrhizin, 18β-glycyrrhetinic acid, liquiritigenin, licoflavonol and isoliquiritigenin are known to have anti-arrhythmic effects through immune regulation and oxidation. Notably, both PCR and ELISA analyses indicated that honey-fried licorice may effectively treat arrhythmia, potentially through the modulation of the arachidonic acid pathway.

CONCLUSION

These results suggested that honey-fried licorice could protect against arrhythmia and alleviate oxidative stress and tissue damage caused by arrhythmia. Through correlation analysis and metabolomics, it was found that glycyrrhetic acid 3-O-glucuronide, isoformononetin, araboglycyrrhizin, 18β-glycyrrhetinic acid, liquiritigenin, licoflavonol and isoliquiritigenin can be used as the active ingredient of honey-fried licorice in the treatment of arrhythmia. Moreover, our results suggested that the therapeutic effect of honey-fried licorice on arrhythmia may be linked to the regulation of the arachidonic acid pathway. This study elucidates the mechanisms by which honey-fried licorice treats arrhythmia from a metabolic perspective, highlighting its role in "tonifying the spleen and stomach, supplementing qi, and replenishing the pulse." These findings provide a foundation for the further application of honey-fried licorice and the development of related products.

Development of a novel tool: a nomogram for predicting in-hospital mortality of patients in intensive care unit after percutaneous coronary intervention

BACKGROUNDS

Increased risk of in-hospital mortality is critical to guide medical decisions and it played a central role in intensive care unit (ICU) with high risk of in-hospital mortality after primary percutaneous coronary intervention (PCI). At present，most predicting tools for in-hospital mortality after PCI were based on the results of coronary angiography, echocardiography, and laboratory results which are difficult to obtain at admission. The difficulty of using these tools limit their clinical application. This study aimed to develop a clinical prognostic nomogram to predict the in-hospital mortality of patients in ICU after PCI.

METHODS

We extracted data from a public database named the Medical Information Mart for Intensive Care (MIMIC III). Adult patients with coronary artery stent insertion were included. They were divided into two groups according to the primary outcome (death in hospital or survive). All patients were randomly divided into training set and validation set randomly at a ratio of 6:4. Least absolute shrinkage and selection operator (LASSO) regression was performed in the training set to select optimal variables to predict the in-hospital mortality of patients in ICU after PCI. The multivariate logistical analysis was performed to develop a nomogram. Finally, the predictive efficiency of the nomogram was assessed by area under the receiver operating characteristic curve (AUROC)，integrated discrimination improvement (IDI), and net reclassification improvement (NRI), and clinical net benefit was assessed by Decision curve analysis (DCA).

RESULTS

A total of 2160 patients were recruited in this study. By using LASSO, 17 variables were finally included. We used multivariate logistic regression to construct a prediction model which was presented in the form of a nomogram. The calibration plot of the nomogram revealed good fit in the training set and validation set. Compared with the sequential organ failure assessment (SOFA) and scale for the assessment of positive symptoms II (SAPS II) scores, the nomogram exhibited better AUROC of 0.907 (95% confidence interval [CI] was 0.880-0.933, p <  0.001) and 0.901 (95% CI was 0.865-0.936, P <  0.001) in the training set and validation set, respectively. In addition, DCA of the nomogram showed that it could achieve good net benefit in the clinic.

CONCLUSIONS

A new nomogram was constructed, and it presented excellent performance in predicting in-hospital mortality of patients in ICU after PCI.

Consumption of whole grains and refined grains and associated risk of cardiovascular disease events and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

BACKGROUND

Although relationships between the intake of whole grains and refined grains and the incidence of cardiovascular disease (CVD) events and all-cause mortality have been investigated, the conclusions have been inconclusive.

OBJECTIVES

We aimed to comprehensively summarize the evidence about the correlation between consuming whole grains and refined grains and risks of CVD events and all-cause mortality and to evaluate the meta-evidence quality.

METHODS

We searched PubMed, Embase, and Web of Science until 15 March, 2022. Random-effects models were employed to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). We explored potential linear or nonlinear relationships using restricted cubic splines. The NutriGrade tool was employed to rate meta-evidence quality.

RESULTS

Twenty-four articles (68 studies; 46 for whole grains and 22 for refined grains) with 1,624,407 participants were included. Per 30-g increase in daily whole grain consumption, the RRs and 95% CIs of stroke, coronary heart disease (CHD), heart failure (HF), CVD, and all-cause mortality were 0.98 (0.96, 1.00), 0.94 (0.92, 0.97), 0.97 (0.89, 1.07), 0.92 (0.88, 0.96), and 0.94 (0.92, 0.97), respectively. Whole grain consumption was linearly associated with CHD (P_nonlinearity = 0.231) and nonlinearly associated with CVD (P_nonlinearity = 0.002) and all-cause mortality (P_nonlinearity = 0.001). Except for a positive correlation between refined grain consumption and all-cause mortality in the restricted cubic spline, no significant influence of refined grain intake on stroke, CHD, HF, and CVD was detected. The meta-evidence quality for the association of whole grain consumption with stroke, CHD, HF, CVD, and all-cause mortality was moderate, moderate, low, high, and high, respectively. For refined grains, all meta-evidence was of low quality.

CONCLUSIONS

Consuming whole grains, rather than refined grains, can assist in preventing CHD, CVD, and all-cause mortality. Relationships between consumption of refined grains and health outcomes should be interpreted cautiously because of the low quality of meta-evidence.

Aconitine induces autophagy via activating oxidative DNA damage-mediated AMPK/ULK1 signaling pathway in H9c2 cells

ETHNOPHARMACOLOGICAL RELEVANCE

Aconitum species, with a medicinal history of 2000 years, was traditionally used in the treatment of rheumatism, arthritis, bruises, and pains. However, many studies have reported that Aconitum species can cause arrhythmia in experimental animals, resulting in myocardial fibrosis and cardiomyocyte damage. Cardiotoxicity is the main toxic effect of aconitine, but the detailed mechanism remains unclear.

AIM OF THE STUDY

This study aimed to explore the effects and underlying mechanism of autophagy in H9c2 cardiomyocytes induced by aconitine.

MATERIALS AND METHODS

H9c2 cells were incubated with different concentrations of aconitine for 24 h, and the intervention sections were pretreated with various inhibitors for 1 h. The effects of aconitine on the oxidative DNA damage, autophagy and viability of H9c2 cells were evaluated by flow cytometry, confocal microscopy, enzyme-linked immunosorbent assay and Western blot.

RESULTS

In H9c2 cells, the cell viability declined, LDH release rate, the number of autophagosomes, protein expression levels of LC3 and Beclin-1 increased significantly after 24 h of aconitine incubation. The pretreatment of autophagy inhibitor 3-MA decreased markedly autophagosomes and protein expression levels of LC3 and Beclin-1, which suggested that aconitine could induce cell autophagy. The significant increase of ROS and 8-OHdG showed that aconitine could cause oxidative DNA damage through ROS accumulation. Meanwhile, treatment of aconitine dramatically increased AMPK^Thr172 and ULK1^Ser317 phosphorylation, and Compound C inhibited AMPK^Thr172 and ULK1^Ser317 phosphorylation, which proved that aconitine induced autophagy via AMPK activation mediated ULK1 phosphorylation. Antioxidant NAC significantly reduced LDH, ROS and 8-OHdG, inhibited the phosphorylation of AMPK^Thr172 and ULK1^Ser317, and down-regulated autophagosomes and proteins expression levels of LC3 and Beclin-1. Consequently, the inhibition of oxidative DNA damage and AMPK/ULK1 signaling pathway alleviated the aconitine-induced autophagic death of H9c2 cells.

CONCLUSIONS

These results showed that aconitine induces autophagy of H9c2 cardiomyocytes by activating AMPK/ULK1 signaling pathway mediated by oxidative DNA damage. The autophagy induced by aconitine in cardiomyocytes is dependent on the activation of the AMPK pathway, which may provide novel insights into the prevention of aconitine-related toxicity.

The Importance of Telomere Shortening for Atherosclerosis and Mortality

Telomeres are the protective end caps of chromosomes and shorten with every cell division. Short telomeres are associated with older age and adverse lifestyle factors. Leucocyte telomere length (LTL) has been proposed as a biomarker of biological age. The shortening of LTL with age is the result of the end-replication problem, environmental, and lifestyle-related factors. Epidemiologic studies have shown that LTL predicts cardiovascular disease, all-cause mortality, and death from vascular causes. Age appears to be an important co-variate that explains a substantial fraction of this effect. Although it has been proposed that short telomeres promote atherosclerosis and impair the repair of vascular lesions, existing results are inconsistent. Oxidative stress and chronic inflammation can both accelerate telomere shortening. Multiple factors, including homocysteine (HCY), vitamin B6, and vitamin B12 modulate oxidative stress and inflammation through direct and indirect mechanisms. This review provides a compact overview of telomere physiology and the utility of LTL measurements in atherosclerosis and cardiovascular disease. In addition, it summarizes existing knowledge regarding the impact of oxidative stress, inflammation, HCY, and B-vitamins on telomere function.

Homocysteine concentration and adenosine A2A receptor production by peripheral blood mononuclear cells in coronary artery disease patients

Hyperhomocysteinemia is associated with coronary artery disease (CAD). The mechanistic aspects of this relationship are unclear. In CAD patients, homocysteine (HCy) concentration correlates with plasma level of adenosine that controls the coronary circulation via the activation of adenosine A_2A receptors (A_2AR). We addressed in CAD patients the relationship between HCy and A_2AR production, and in cellulo the effect of HCy on A_2AR function. 46 patients with CAD and 20 control healthy subjects were included. We evaluated A_2AR production by peripheral blood mononuclear cells using Western blotting. We studied in cellulo (CEM human T cells) the effect of HCy on A_2A R production as well as on basal and stimulated cAMP production following A_2A R activation by an agonist‐like monoclonal antibody. HCy concentration was higher in CAD patients vs controls (median, range: 16.6 [7‐45] vs 8 [5‐12] µM, P < 0.001). A_2A R production was lower in patients vs controls (1.1[0.62‐1.6] vs 1.53[0.7‐1.9] arbitrary units, P < 0.001). We observed a negative correlation between HCy concentration and A_2A R production (r = −0.43; P < 0.0001), with decreased A_2A R production above 25 µM HCy. In cellulo, HCy inhibited A_2AR production, as well as basal and stimulated cAMP production. In conclusion, HCy is negatively associated with A_2A R production in CAD patients, as well as with A_2A R and cAMP production in cellulo. The decrease in A_2A R production and function, which is known to hamper coronary blood flow and promote inflammation, may support CAD pathogenesis.

Association of Elevated Plasma Homocysteine Level with Restenosis and Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic Review and Meta-analysis

PURPOSE

We conducted this systemic review and meta-analysis to investigate the association between elevated plasma homocysteine (Hcy) levels and recurrent restenosis and clinical outcomes after percutaneous coronary intervention (PCI).

METHODS

PubMed, EMBASE, and Web of Science were systematically searched prior to May 2018. Studies evaluating the association between plasma Hcy levels and the occurrence of restenosis, major adverse cardiac events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization were identified.

RESULTS

A total of 19 articles with 4340 participants were identified. Higher Hcy levels were not associated with an increased risk of restenosis (relative risk (RR) = 1.10, 95% CI 0.90-1.33). Hcy levels in the restenosis group were not significantly higher than in the non-restenosis group (weighted mean difference = 0.70, 95% CI - 0.23-1.63). Subgroup analysis revealed that higher Hcy levels were not associated with restenosis after stenting but appeared to increase the risk of restenosis after angioplasty. Elevated Hcy levels increased the risk of all-cause mortality by an average of 3.19-fold (RR = 3.19, 95% CI 1.90-5.34, P = 0.000), the risk of MACE by 1.51-fold (RR = 1.51, 95% CI 1.23-1.85, P = 0.000), and the risk of cardiac death by 2.76-fold (RR = 2.76, 95% CI 1.44-5.32, P = 0.000) but appeared not to increase the risk of non-fatal MI (RR = 1.36, 95% CI 0.89-2.09).

CONCLUSIONS

Our meta-analysis suggests that although there is no clear association between higher Hcy levels and restenosis following stent implantation, higher Hcy levels appeared to increase the risk of restenosis after coronary angioplasty and also increased the risk of all-cause mortality, MACE, and cardiac death after PCI.

REGISTRATION DETAILS

The protocol of this meta-analysis was registered on PROSPERO (CRD42018096466). ( http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466 ).

Endothelial nitric oxide synthase genotypes modulate peripheral vasodilatory properties after myocardial infarction

BACKGROUND

Studies in population genetics suggest an important relationship between the eNOS G894T polymorphism and occurrence of acute myocardial infarction (AMI), with little known on its influence on the post-AMI period.

AIM

To investigate the association of allelic variants produced by the G894T transversion in eNOS (rs1799983) with post-AMI variables.

METHODS

Cross-sectional analyses of anthropometric, clinical and laboratory assessments obtained within the first 24h and after 5 and 30 days of the AMI event across T carriers and G homozygotes of eNOS in 371 consecutive cases of AMI with ST-segment elevation admitted to a Brazilian emergency service in cardiology. Genotypes were determined by polymerase chain reaction followed by enzymatic restriction.

RESULTS

Despite no difference between genotypic groups on aspects as Killip-Kimbal classification scores, extension of infarcted mass, lipid profile or pattern of medication use, an increase in serum nitric oxide from admission to day 5 was higher for T carriers (p<0.001). Thirty days post-AMI, peripheral blood flow reserve was larger among T carriers either by flow- (p=0.037) and nitrate-mediated (p=0.040) dilation testing.

CONCLUSION

Our results suggest an association of the eNOS 894T allele with an apparent improvement in late arterial function in post-AMI patients.

Uric acid and mild renal impairment in patients with ST-elevation myocardial infarction

AIMS

Mild renal impairment (estimated GFR 60-89 ml/min/1.73 m(2)) is a strong independent risk factor for mortality in ST-elevation myocardial infarction (STEMI), and is submitted to mechanical revascularization. Patients with renal impairment have decreased excretion of uric acid (UA) and they are thus particularly prone to have elevated serum UA concentrations. This study was aimed at assessing the association between increased UA and mortality in STEMI patients with mild renal impairment.

METHODS

We prospectively assessed, in 578 STEMI patients with mild renal impairment, whether elevated UA levels are associated with increased mortality both in the short term and in the long term.

RESULTS

Patients in the highest UA tertile showed a higher incidence of Killip class III-IV (p = 0.003) and lower values of ejection fraction (EF) (p < 0.001). Lower values for estimated glomerular filtration rate (eGFR) at admission, nadir, and discharge were detected in the highest UA tertile, together with the highest values of peak troponin I (Tn I) (p = 0.002), and NT-proBrain Natriuretic Peptide [NT-proBNP] (p < 0.001). No difference was found in mortality rates (both during their stay in the intensive cardiac care unit [ICCU], and at the 1-year post-discharge follow-up) among the UA tertiles.

CONCLUSIONS

The UA levels seem to serve as markers of the severity of coronary artery disease, since they identify a subset of patients characterized by an advanced age, more hemodynamic derangement, and reduced renal function. However, neither short nor long-term mortality was affected.

Age-specific gender differences in early mortality following ST-segment elevation myocardial infarction in China

OBJECTIVE

To assess whether younger, but not older, women in China have higher in-hospital mortality following ST-Segment Elevation Myocardial Infarction (STEMI) compared with men, and whether this relationship varied over the last decade or across rural/urban areas.

METHODS

We analysed a nationally representative sample of 11 986 patients with STEMI from 162 Chinese hospitals in 2001, 2006 and 2011, in the China PEACE-Retrospective AMI Study and compared in-hospital mortality between women and men with gender-age interactions in multivariable models.

RESULTS

The overall in-hospital mortality rate was higher in women compared with men (17.2% vs 9.1%, p<0.0001; unadjusted OR 2.07, 95% CI 1.85 to 2.33). The unadjusted OR for mortality in women, compared with men, was 2.20 (95% CI 1.59 to 3.04), 2.21 (95% CI 1.74 to 2.79), 1.37 (95% CI 1.15 to 1.65) and 1.25 (95% CI 0.97 to 1.63) for ages <60, 60-69, 70-79 and ≥80 years, respectively. After adjustment for patient characteristics, hospital characteristics and year of study, the OR for mortality comparing women with men was 1.69 (95% CI 1.01 to 2.83), 1.64 (95% CI 1.24 to 2.19), 1.15 (95% CI 0.90 to 1.46) and 0.82 (95% CI 0.60 to 1.11) for ages <60, 60-69, 70-79 and ≥80 years, respectively. The gender-age interaction for mortality was statistically significant (p=0.009), even after adjustment for a wide range of confounders, and did not vary over time or across rural/urban areas.

CONCLUSIONS

Among a Chinese population with STEMI, gender differences in early mortality were age-dependent and greatest in the younger groups <70 years of age.

TRIAL REGISTRATION NUMBER

http://www.clinicaltrials.gov (NCT01624883).