coronary syndromes
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2022 ◽  
Vol 23 (2) ◽  
pp. 927
Author(s):  
Giovanni Civieri ◽  
Laura Iop ◽  
Francesco Tona

Angiotensin II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) are G-protein-coupled receptors (GPCRs) expressed on the surface of a great variety of cells: immune cells, vascular smooth cells, endothelial cells, and fibroblasts express ETAR and AT1R, which are activated by endothelin 1 (ET1) and angiotensin II (AngII), respectively. Certain autoantibodies are specific for these receptors and can regulate their function, thus being known as functional autoantibodies. The function of these antibodies is similar to that of natural ligands, and it involves not only vasoconstriction, but also the secretion of proinflammatory cytokines (such as interleukin-6 (IL6), IL8 and TNF-α), collagen production by fibroblasts, and reactive oxygen species (ROS) release by fibroblasts and neutrophils. The role of autoantibodies against AT1R and ETAR (AT1R-AAs and ETAR-AAs, respectively) is well described in the pathogenesis of many medical conditions (e.g., systemic sclerosis (SSc) and SSc-associated pulmonary hypertension, cystic fibrosis, and allograft dysfunction), but their implications in cardiovascular diseases are still unclear. This review summarizes the current evidence regarding the effects of AT1R-AAs and ETAR-AAs in cardiovascular pathologies, highlighting their roles in heart transplantation and mechanical circulatory support, preeclampsia, and acute coronary syndromes.


2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Vasileios Panoulas ◽  
Charles Ilsley

Introduction. We aimed to identify the independent “frontline” predictors of 30-day mortality in patients with acute coronary syndromes (ACS) and propose a rapid cardiogenic shock (CS) classification and management pathway. Materials and Methods. From 2011 to 2019, a total of 11439 incident ACS patients were treated in our institution. Forward conditional logistic regression analysis was performed to determine the “frontline” predictors of 30 day mortality. The C-statistic assessed the discriminatory power of the model. As a validation cohort, we used 431 incident ACS patients admitted from January 1, 2020, to July 20, 2020. Results. Independent predictors of 30-day mortality included age (OR 1.05; 95% CI 1.04 to 1.07, p < 0.001 ), intubation (OR 7.4; 95% CI 4.3 to 12.74, p < 0.001 ), LV systolic impairment (OR severe_vs_normal 1.98; 95% CI 1.14 to 3.42, p = 0.015 , OR moderate_vs_normal 1.84; 95% CI 1.09 to 3.1, p = 0.022 ), serum lactate (OR 1.25; 95% CI 1.12 to 1.41, p < 0.001 ), base excess (OR 1.1; 95% CI 1.04 to 1.07, p < 0.001 ), and systolic blood pressure (OR 0.99; 95% CI 0.982 to 0.999, p = 0.024 ). The model discrimination was excellent with an area under the curve (AUC) of 0.879 (0.851 to 0.908) ( p < 0.001 ). Based on these predictors, we created the SAVE (SBP, Arterial blood gas, and left Ventricular Ejection fraction) ACS classification, which showed good discrimination for 30-day AUC 0.814 (0.782 to 0.845) and long-term mortality p log − rank < 0.001 . A similar AUC was demonstrated in the validation cohort (AUC 0.815). Conclusions. In the current study, we introduce a rapid way of classifying CS using frontline parameters. The SAVE ACS classification could allow for future randomized studies to explore the benefit of mechanical circulatory support in different CS stages in ACS patients.


2022 ◽  
Vol 9 (1) ◽  
pp. 59-64
Author(s):  
Tamaray Sahitra ◽  
Fuadi Haizil

Wellens syndrome is a pre-infarct stage of coronary syndrome and a clinical condition associated with left descending proximal anterior artery stenosis. Diagnostic criteria for Wellens syndrome include clinical history, ECG changes, and laboratory results. The pathognomonic ECG of Wellens syndrome is anterior inverted T-wave in precordial leads, which can be seen during pain-free period, accompanied by isoelectric or minimally elevated ST segment (<1 mm), no precordial Q waves, and normal or slightly elevated cardiac serum markers. Early diagnosis leads to early management and a better prognosis. Early management of Wellens syndrome involves maintaining an airway, breathing, circulation, monitoring vital signs, and medical management. Still, the only definitive management is urgent cardiac angiography to prevent further myocardial ischemia. The combination of early diagnostic and appropriate management will reduce complications and mortality rates. Keywords: Wellens Syndrome, Acute Coronary Syndromes, pre-Infarct MI.


2022 ◽  
Author(s):  
Huiyan Ma ◽  
Libo Yang ◽  
Ning Yan ◽  
Hua Zhang ◽  
Xiaoxia Zhang ◽  
...  

Abstract Background: Acute coronary syndromes (ACS) is closely associated with chronic low-grade inflammation and gut microbiome composition. However, the composition and functional capacity of the gut microbiome in relation to ACS have not been systematically examined. Results: we perform a metagenome-wide association study on stools and plasma from 66 individuals with ACS and 46 healthy controls (HC). We then compared gut microbial composition using 16S ribosomal RNA gene sequencing in fecal samples to detect species with differential abundance between 2 groups. We reported that the altered composition of gut microbiota was associated with ACS and exacerbated inflammatory status. Moreover, parameters in ACS including body weights (BWs), low-density lipoprotein (LDL), triglyceride (TG), total cholesterol (TC), C-reactive protein (CRP) and high homocysteine (HCY) were elevated; whereas high-density lipoprotein (HDL) was decreased. pro-inflammatory interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor (TNF)-α, monocyte chemoattractant protein-1(MCP-1) and lipopolysaccaride (LPS) in ACS were increased respectively. The results of 16S rRNA sequencing and analysis displayed that the overall community of gut microbiota in ACS was notably changed mainly through increasing the abundance of Bacteroidetes, Verrucomicrobia, Proteobacteria Parabacteroide, Unidentified_Enterobacteriaceae, Subdoligranulum, Akkermansia, Alistipes, Streptococcus, Paraprevotella as well as decreasing Subdoligranulum, Roseburia, Faecalibacterium, Blautia, Agathobacter, Anaerostipes, Bifidobacterium. Further analysis showed that there was a significant correlation between the above differences in gut microbiota and inflammatory factors. Conclusions: Our data represent a comprehensive resource for further investigations on the role of the gut microbiome in promoting or preventing ACS.


2022 ◽  
Vol 12 ◽  
Author(s):  
Jin-Yu Zhang ◽  
Qian Zhao ◽  
Fen Liu ◽  
De-Yang Li ◽  
Li Men ◽  
...  

Genetic variation of macrophage migration inhibitory factor (MIF) gene has been linked to coronary artery disease. We investigated an association between the polymorphism of MIF gene rs2070766 and acute coronary syndromes (ACS) and the predictive value of MIF gene variation in clinical outcomes. This study involved in 963 ACS patients and 932 control subjects from a Chinese population. All participants were genotyped for the single nucleotide polymorphism (SNP) of MIF gene rs2070766 using SNPscan™. A nomogram model using MIF genetic variation and clinical variables was established to predict risk of ACS. Major adverse cardiovascular events (MACE) were monitored during a follow-up period. The frequency of rs2070766 GG genotype was higher in ACS patients than in control subjects (6.2 vs 3.8%, p = 0.034). Multivariate logistic regression analysis revealed that individuals with mutant GG genotype had a 1.7-fold higher risk of ACS compared with individuals with CC or CG genotypes. Using MIF rs2070766 genotypes and clinical factors, we developed a nomogram model to predict risk of ACS. The nomogram model had a good discrimination with an area under the curve of 0.781 (95% CI: 0.759–0.804), concordance index of 0.784 (95% CI: 0.762–0.806) and well-fitted calibration. During the follow-up period of 25 months, Kaplan-Meier curves demonstrated that ACS patients carrying GG phenotype developed more MACE compared to CC or CG carriers (p &lt; 0.05). GG genotype of MIF gene rs2070766 was associated with a higher risk of ACS in a Chinese population. The GG genotype carriers in ACS patients had worse clinical outcomes compared with those carrying CC or CG genotype. Together with rs2070766 genetic variant of MIF gene, we established a novel nomogram model that can provide individualized prediction for ACS.


Author(s):  
Essa Hariri ◽  
Ibrahim Kassas ◽  
Mazen Al Hammoud ◽  
Barinder Hansra ◽  
Mohammed W Akhter ◽  
...  

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