Current Issue

2023, Volume 20,  Issue 5

One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach
Smit Paghdar, Smruti Desai, Ji-Min Jang, Jose Ruiz, Sharan Malkani, Parag Patel, Daniel S Yip, Juan C Leoni, Jose Nativi, Basar Sareyyupoglu, Kevin Landolfo, Si Pham, Rohan M Goswami
2023, 20(5): 319-329. doi: 10.26599/1671-5411.2023.05.002
Abstract(270) FullText HTML (133) PDF(19)
 BACKGROUND Optimizing patients with advanced heart failure before orthotopic heart transplantation (OHT), especially in patients greater than 50 years old, is imperative to achieving successful post-transplant outcomes. Complications are well-described for patients bridged to transplant (BTT) with durable left ventricular assist device (LVAD) support. Given the lack of data available in older recipients after the recent increase in mechanical support use, we felt it crucial to report our center’s one-year outcomes in older recipients after heart transplantation with percutaneously placed Impella 5.5 as a BTT.  METHODS Forty-nine OHT patients were supported with the Impella 5.5 intended as a bridge between December 2019 and October 2022 at Mayo Clinic in Florida. Data were extracted from the electronic health record at baseline and during their transplant episode of care after Institutional Review Boards approval as exempt for retrospective data collection.  RESULTS Thirty-eight patients aged 50 or older were supported with Impella 5.5 as BTT. Ten patients underwent heart and kidney transplantation within this cohort. The median age at OHT was 63 (58–68) years, with 32 male (84%) and six female patients (16%). Etiology was divided into ischemic (63%) and non-ischemic cardiomyopathy (37%). The baseline median ejection fraction was 19% (15–24). Most patients were in blood group O (60%), and 50% were diabetic. The average duration of support was 27 days (range 6–94). The median duration of follow-up is 488 days (185–693). For patients that have reached the 1-year follow-up timeframe (22 of 38, 58%), the 1-year post-transplant survival is 95%.  CONCLUSION Our single-center data provides awareness for using the Impella 5.5 percutaneously placed axillary support device in older heart failure patients in cardiogenic shock as a bridge to transplantation. One-year survival outcomes after heart transplantation are excellent despite the older recipient’s age and prolonged pre-transplant support.
Predictive validation of existing bleeding and thromboembolic scores in elderly patients with comorbid atrial fibrillation and acute coronary syndrome
Hong-Hong ZHANG, Qi LIU, Hai-Jing ZHAO, Ya-Ni YU, Liu-Yang TIAN, Ying-Yue ZHANG, Zi-Hao FU, Li ZHENG, Yue ZHU, Yu-Han MA, Shuang LI, Yang-Yang MA, Yu-Qi LIU
2023, 20(5): 330-340. doi: 10.26599/1671-5411.2023.05.001
 BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation (AF) and acute coronary syndrome (ACS) has not been reported. The present study compared the predictive performance of existing risk scores in these patients.  METHODS A total of 1252 elderly patients with AF and ACS comorbidities (≥ 65 years old) were consecutively enrolled from January 2015 to December 2019. All patients were followed up for one year. The predictive performance of risk scores in predicting bleeding and thromboembolic events was calculated and compared.  RESULTS During the 1-year follow-up, 183 (14.6%) patients had thromboembolic events, 198 (15.8%) patients had BARC class ≥ 2 bleeding events, and 61 (4.9%) patients had BARC class ≥ 3 bleeding events. For the BARC class ≥ 3 bleeding events, discrimination of the existing risk scores was low to moderate, PRECISE-DAPT (C-statistic: 0.638, 95% CI: 0.611-0.665), ATRIA (C-statistic: 0.615, 95% CI: 0.587-0.642), PARIS-MB (C-statistic: 0.612, 95% CI: 0.584-0.639), HAS-BLED (C-statistic: 0.597, 95% CI: 0.569-0.624) and CRUSADE (C-statistic: 0.595, 95% CI: 0.567-0.622). However, the calibration was good. PRECISE-DAPT showed a higher integrated discrimination improvement (IDI) than PARIS-MB, HAS-BLED, ATRIA, and CRUSADE (P < 0.05) and the best decision curve analysis (DCA). For thromboembolic events, the discrimination of GRACE (C-statistic: 0.636, 95% CI: 0.608-0.662) was higher than CHA2DS2-VASc (C-statistic: 0.612, 95% CI: 0.584-0.639), OPT-CAD (C-statistic: 0.602, 95% CI: 0.574-0.629) and PARIS-CTE (C-statistic: 0.595, 95% CI: 0.567-0.622). The calibration was good. Compared to OPT-CAD and PARIS-CTE, the IDI of the GRACE score slightly improved (P < 0.05). However, NRI analysis showed no significant difference. DCA showed that the clinical practicability of thromboembolic risk scores was similar.  CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS. PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class ≥ 3 bleeding events. The GRACE score showed a slight advantage in predicting thrombotic events.
Identification of an LDLR variant in a Chinese familial hypercholesterolemia and its relation to ROS/NLRP3-Mediated pyroptosis in hepatic cells
Wen-Zhuo CHENG, Wei-Hua WANG, Ai-Ping DENG, Xiao DANG, Chao LIU, Xian-Can WANG, Ju-Yi LI, Si JIN
2023, 20(5): 341-349. doi: 10.26599/1671-5411.2023.05.003
 BACKGROUND  Familial hypercholesterolemia (FH) is a common autosomal dominant hereditary disease. Its early diagnosis and intervention significantly improve the patient’s quality of life. However, there are few types of research on the FH pathogenic genes in China.  METHODS  In this study, we recruited a family diagnosed with FH and used whole exome sequencing (WES) to analyze the proband variants. Intracellular cholesterol level, reactive oxygen species (ROS) level, and the expression of pyroptosis-related genes were detected after overexpression of wild-type or variant LDLR in L02 cells.  RESULTS A heterozygous missense variant predicted to be deleterious to LDLR (c.1879G > A, p.Ala627Thr) was identified in the proband. Mechanistically, intracellular cholesterol level, ROS level, and the expression of pyroptosis-related genes, nucleotide-binding oligomerization domain-like receptor family protein 3 (NLRP3) inflammasome and components (caspase 1, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) and NLRP3), gasdermin D (GSDMD), interleukin (IL) -18, IL-1β was elevated in the variant LDLR group, which was attenuated by inhibition of ROS.  CONCLUSIONS  FH is associated with a variant (c.1879G>A, p.Ala627Thr) in the LDLR gene. Regarding the mechanism, the ROS/NLRP3-mediated pyroptosis in hepatic cells may contribute to the pathogenesis of the LDLR variant.
A circRNA–miRNA–mRNA network analysis underlying pathogenesis of human heart failure
Ran XU, Jian WU, Chun-Jie YANG, Le KANG, Yu-Yao JI, Chang LI, Zhi-Wen DING, Yun-Zeng ZOU
2023, 20(5): 350-360. doi: 10.26599/1671-5411.2023.05.004
 BACKGROUND The molecular mechanisms of heart failure (HF) are still poorly understood. Circular RNA (circRNA) has been discovered in the heart in increasing numbers of studies. The goal of this research is to learn more about the potential roles of circRNAs in HF.  METHODS & RESULTS  We used RNA sequencing data to identify the characteristics of circRNAs expressed in the heart and discovered that the majority of circRNAs screened were less than 2000 nt. Additionally, chromosomes One and Y had the most and least number of circRNAs, respectively. After excluding duplicate host genes and intergenic circRNAs, a total of 238 differentially expressed circRNAs (DECs) and 203 host genes were discovered. However, only four of the 203 host genes of DECs were examined in HF differentially expressed genes. Another study used Gene Oncology analysis of DECs host genes to elucidate the underlying pathogenesis of HF, and it found that binding and catalytic activity accounted for a large portion of DECs. Immune system, metabolism, and signal transduction pathways were significantly enriched. Furthermore, 1052 potentially regulated miRNAs from the top 40 DECs were collected to build a circRNA-miRNA network, and it was discovered that 470 miRNAs can be regulated by multiple circRNAs, while others are regulated by a single circRNA. In addition, a comparison of the top 10 mRNAs in HF and their targeted miRNAs revealed that DDX3Y and UTY were regulated by the most and least circRNA, respectively.  CONCLUSION  These findings demonstrated circRNAs have species and tissue specific expression patterns; while circRNA expression is independent on host genes, the same types of genes in DECs and DEGs worked in HF. Our findings would contribute to a better understanding of the critical roles of circRNAs and lay the groundwork for future studies of HF molecular functions.
Cardiac amyloidosis: state-of-the-art review
Syed Bukhari
2023, 20(5): 361-375. doi: 10.26599/1671-5411.2023.05.006
Cardiac amyloidosis (CA) is caused by deposition of amyloid fibrils in the myocardium and has two main subtypes, transthyretin cardiac amyloidosis (ATTR) and immunoglobulin light chain cardiac amyloidosis (AL). ATTR is further differentiated into wild-type (wtATTR) and hereditary (hATTR), depending on the absence or presence of mutation in the transthyretin gene. The increased recognition of disease with the improvement in diagnostic armamentarium and serendipitous advancements in the therapeutic landscape have changed the status of CA from being a rare and untreatable disease to being a not-so-rare and treatable disease. Both ATTR and AL have certain clinical aspects that can provide early clues for the disease. While electrocardiography followed by echocardiography and subsequently cardiac magnetic resonance can raise suspicion for CA, the definitive diagnosis of ATTR is non-invasively established by bone scintigraphy while that of AL always needs histological confirmation. Severity of CA can be gauged by serum biomarker-based staging of both ATTR and AL. ATTR therapies work by silencing or stabilizing TTR or by degrading amyloid fibrils, while AL is managed with anti-plasma cell therapies and autologous stem cell transplant.
Ultrasound-guided stellate ganglion blockade: an appealing tactic for cardiac electrical storm
Zi-Hao LAI, Li-Hui ZHENG, Yan YAO
2023, 20(5): 376-382. doi: 10.26599/1671-5411.2023.05.009
A faraway complex bifurcation hidden behind an occluded left main in an elderly patient
Gianluca Rigatelli, Giulio Rodino, Giuseppe Marchese, Marco Zuin
2023, 20(5): 383-385. doi: 10.26599/1671-5411.2023.05.007
Risk analysis of gastrointestinal bleeding in hospital patients with acute myocardial infarction undergoing primary PCI
Yan-Yan JIN, Ming YE, Hai GAO
2023, 20(5): 386-390. doi: 10.26599/1671-5411.2023.05.005
From post-COVID-19-associated myocarditis to hemopericardium: a dangerous domino effect
Francesco Bellanti, Ripalta Amato, Antonio Centola, Valeria Ercolano, Lucia Barbera, Annamaria Tesse, Grazia Divittorio, Cristiano Capurso, Aurelio Lo Buglio, Gianluigi Vendemiale
2023, 20(5): 391-396. doi: 10.26599/1671-5411.2023.05.008