All Articles

Patrick Dunn^1,2*, Scott Conard³

¹Walden University, Minneapolis, MN, USA

²American Heart Association, Dallas, TX, USA

³Converging Health, Dallas, TX, USA

Cristina Aurigemma^1*, Francesco Burzotta², Carlo Trani²

¹Institute of Cardiology, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy

²Institute of Cardiology, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Despite 20 years of investigation the Completeness of Revascularization in patients with multivessel coronary artery disease (CAD) remains an unanswered question. The lack of universal definition and the multiplicity of confounding variables that in general favor patients who receive a complete revascularization (CR) are the reason of studies’ conflicting results.

The CR is achieved more commonly with coronary artery by-pass (CABG) than with percutaneous coronary intervention (PCI). In this regard, the possibility of achieving CR is one of variable that should be factored when deciding the optimal strategy of revascularization between PCI and CABG in patients with multivessel coronary artery disease. However clinical features, such as patient’s age, life expectancy, symptoms at presentation, comorbidities and left ventricular function may increase the morbidity or mortality risk of CABG intervention and a “reasonable” incomplete revascularization (IR) achieved with PCI may be a better choice in particular clinical subset.

Penuelas, J^1,2* & Sardans, J^1,2*

¹ CSIC, Global Ecology Unit CREAF-CEAB-UAB, Cerdanyola del Vallès, 08193 Catalonia, Spain

² CREAF, Cerdanyola del Vallès, 08193 Catalonia, Spain

Rich countries have higher per capita food N and P intake than poor countries. This difference translates into higher human height. The differences among countries provide additional evidence on geopolitical disequilibrium in human wellness distribution but it also may have consequences on the incidence of hearth health. More N and P fertilizer sources are necessary, and they have to be adequately used in poor-countries to solve this additional gap between rich and poor countries.

Clement Kleinstreuer ^1,2*, Sriram Vasudevan Chari ¹, Shantanu Vachhani ¹

¹Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, United States

²Joint UNC-NCSU Department of Biomedical Engineering, Raleigh, NC 27695, United States

Barth U¹, Wasseroth K¹, Meyer F^2*

¹Center of Vascular medicine, Aschersleben / Schönebeck (certified by the “German Society for Vascular Surgery and Vascular Medicine“), AMEOS Hospital, Schönebeck, Germany

²Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital at Magdeburg, Magdeburg, Germany

Introduction: A material-associated non-anastomotic aneurysm after previous use of a vascular prosthesis for arterial reconstruction mostly in peripheral arterial occlusion disease (PAOD) is considered a rare but serious complication.

Aim & method: The aim of the compact short review was – based on selected topic-related references from the medical literature as – to describe the rare finding of prosthetic non-anastomotic aneurysm and its diagnosis-specific care.

Results (complex patient- & clinical finding-associated corner points): Twenty articles were finally evaluated out of initially 321 references found in the literature search, which had been published since 1995. Most frequently, pseudoaneurysms of knitted polyester prostheses at the femoro-popliteal segment occurred after approximately 12.9 years in average. In one third of cases, two or more non-anastomotic aneurysms of Dacron prostheses were described. Histological and electron-microscopic investigations revealed mainly breakings of filaments and foreign body reactions. In more than half of the patients, the non-anastomotic aneurysm was resected and for reconstruction, a novel vascular prosthesis used as inter-positioned vascular segment was implanted. Complete removal of the prosthesis and endovascular therapy were only 2nd choice.

Conclusion: Development of prosthetic non-anastomotic aneurysms has not been satisfyingly clarified yet. It belongs to the late complication profile - even it occurs rarely - and should be controlled after a postoperative interval of approximately one decade if the arterial recanalization/reconstruction was performed using prosthetic material after previously – in the sequential approach – endovascular intervention and venous bypass could not be used.

Gundu H. R. Rao^1,2*

¹Emeritus Professor, Department of Laboratory Medicine and Pathology, Minneapolis, MN, USA

²Director Thrombosis Research, Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, USA

Allen PF Chen^1,2*, Rachel Kéry^1,2, and Shaoyu Ge¹

¹Medical Scientist Training Program, Stony Brook, New York, USA

²Department of Neurobiology & Behavior, SUNY Stony Brook, Stony Brook, NY 11794, USA

The acute nature of neurological stroke disorders highlights the massive dependence of the brain on oxygen and energy supplies. The mechanisms of neural blood flow regulation have been intensely studied but are still unclear. Astrocytes are glial cells that communicate with both neurons and blood vessels, making them a cellular candidate for mediating neuronal blood flow. Evidence suggests that perivascular astrocytes of the brain do in part mediate blood flow corresponding to neuronal activity. However, the role of astrocytes in this respect is still to be defined and characterized. Fortunately, many recent technologies have emerged that allow us to investigate how astrocytes may accomplish this task. Gene expression strategies with rodent lines and viral transduction have allowed us to investigate astrocytes in a more targeted manner. Additionally, a variety of tools used previously to study neurons are now being applied to astrocytes. Studying how astrocytes may orchestrate brain blood flow is important for our ability to understand and treat neurovascular disease. We review current methods used to experimentally target, monitor, and manipulate astrocytes in the context of mediating neuronal blood flow.

Adrian Wells^1,2,* & Cintia Faija^1,2

¹The University of Manchester, School of Psychological Sciences, Faculty of Biology, Medicine and Health, Oxford Road, Manchester, M13 9PL, United Kingdom

²Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester, M13 9WL, United Kingdom

Anxiety and depression are common amongst cardiac patients undergoing cardiac rehabilitation and are associated with poorer health, poor quality of life and higher economic costs. There is a paucity of effective psychological treatments and their provision in this care pathway. A new treatment that is proving highly effective in mental health settings, named metacognitive therapy (MCT), could offer a way forward. This commentary delineates the problem of psychological distress (defined by anxiety and depression symptoms) in cardiac rehabilitation, highlights the limitations of current treatment and describes the PATHWAY research programme funded by the UK National Institute of Health Research (NIHR) to translate and test the metacognitive therapy in this population.

Dongmei Gao¹ & Wenhua Li^1,2*

¹Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, 221002, China

²Department of Cardiology, The Affiliated Hospital Of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, China

Contrast agent induced acute kidney injury (CI-AKI) is a leading cause of hospital-acquired acute kidney injury as a result of more and more iodinated contrast-media use for diagnostic purposes. Previous studies have demonstrated that oxidative stress and apoptosis are established processes contributing to contrast agent induced acute kidney injury. Astaxanthin (ATX), a carotenoid found in microalgae, fungi, complex plants, seafood, flamingos and quail has been confirmed have anti-oxidant, and anti-apoptosis effects. Experimental investigations in a range of species using a contrast agent induced acute kidney injury model demonstrated kidney preservation when ATX is administered prior to the induction of contrast agent. ATX?as an natural antioxidant?is capable to prevent CI-AKI effectively?and the mechanism is possibly related to anti-oxidant and anti-apoptosis. In this mini review, we brie?y summarize the potential for ATX as a protector against CI-AKI pathologies.

Debjit Chatterjee*

Consultant Cardiologist, Queens Hospital, Burton on Trent, UK

This is a rare coronary angiogram showing myocardial bridge affecting more than one coronary artery.

Paul M. Starker^1*, Bertram Chinn²

¹Overlook Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

²Division of Colon and Rectal Surgery, Overlook Medical Center, Robert Wood Johnson Medical School, New Brunswick, NJ, USA

Huaqing Chen^1*, Dali Li¹, Mingyao Liu^1,2*

¹Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences, School of Life Sciences, East China Normal University, Shanghai, China

²Institute of Biosciences and Technology, Department of Molecular and Cellular Medicine, Texas A&M University Health Science Center, Houston, Texas, USA

Mouse models have been widely used in atherosclerosis research and related therapy development. However, data suggested that it was difficult to translate discovery in mice to human. Thanks to the fast development and optimization in gene editing technology, atherosclerotic models in rats generated recently provide more options for different studies and could make a difference to the situation which is exclusively dependent on mouse. Here we reviewed novel rat models for atherosclerosis generated through genetic approaches in recent years, including Ldl receptor (Ldlr) and apolipoprotein e (Apoe) knockout rats. The phenotypes in hyperlipidemia, atherosclerosis, as well as related inflammatory responses, were compared. These models developed typical atherosclerosis. More importantly, some of them present certain advantages over mouse models. These not only provide novel options for animal models of atherosclerosis, but also will benefit future investigations of atherosclerotic pathology and anti-atherosclerotic therapeutics.

Ozaifa Kareem¹, Masood Tanvir², Amreen Naqash¹, and G. N. Bader^1*

¹Department of Pharmaceutical Sciences, University of Kashmir, Hazratbal Srinagar, Kashmir, India

²Department of General Medicine, Government Medical College Srinagar, India

Obstructive Sleep Apnoea (OSA) is the most prevalent condition among sleep disordered breathing that leads to increased risk of cardiovascular (CV) and cerebrovascular morbidity and mortality. The most common comorbidity associated with OSA is systemic hypertension (HTN). Various epidemiological studies suggest a link between OSA and hypertension that involves complex interactions between various pathophysiological mechanisms and metabolic risk factors. OSA causes changes in normal physiological functions during nocturnal apneic episodes which in-turn lead to daytime hypertension. The widely accepted mechanisms by which the OSA contributes to the development of hypertension include sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. OSA and hypertension coexist in millions of people and both have been associated with heart disease, stroke, and premature death. Worldwide the prevalence of hypertension in OSA is estimated between 30 and 70%, thus setting it off as a major public health problem. Furthermore, not only has OSA been implicated in causing new hypertension but also it is said to promote resistant hypertension in already existent hypertensive patients, which may further grim the clinical and therapeutic outcomes. It is necessary to recognize the underlying OSA in-order to decrease the overall healthcare burden in terms of rigorous anti-hypertensive therapy instituted to OSA subjects. The review summarizes an up-to-date scenario of obstructive sleep apnoea as a cause of systemic hypertension and the overall cardiovascular risks.

Volker Walhorn¹, Mareike Dieding¹, Jana Davina Debus², Raimund Kerkhoff¹, Anna Gärtner-Rommel², Hendrik Milting², and Dario Anselmetti¹

¹Experimental Biophysics, Physics Faculty, Bielefeld University, D-33615 Bielefeld, Germany

²Erich & Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Center NRW,University Hospital of the Ruhr-University Bochum, D- 32545 Bad Oeynhausen, Germany

Cadherins are calcium dependent adhesion proteins that bridge the intercellular gap and establish a tight connection to adjacent cells. Desmoglein-2 (DSG2) is a specific cadherin of the cell-cell contact in cardiac desmosomes. Mutations in the DSG2 gene are associated with rare but severe heart muscle diseases such as arrhythmogenic right ventricular cardiomyopathy (ARVC). However, the molecular pathomechanism of many DSG2 mutations is unknown. In our recently published research, we report on the homophilic binding properties of wildtype DSG2 and two mutations thereof. We found that wildtype DSG2 binding kinetics differs significantly from the two analyzed mutations whereas thermodynamic properties such as the difference in Gibbs free energy are virtually unaffected. Here, we comment on (bio-) physical concepts how non-covalent bonds are characterized and we highlight the limitations of these concepts. Furthermore, we consistently link molecular binding properties of DSG2 with the macroscopic stability of cellular networks overexpressing a distinct DSG2 species. Finally, on the basis of DSG2 binding kinetics, we draft a biophysically inspired hypothesis of a molecular pathomechanism leading to ARVC.

Lu Feng¹, Gexin Zhao^2*, Beidong Chen^1*

^*1The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China

^*2Technology Center for Genomics & Bioinformatics. Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, California 90095, USA

Atherosclerosis is a chronic inflammation disease that is initiated by endothelial cell injury. Hyperlipidemia is an independent risk factor for atherosclerosis. Oxidized low-density lipoprotein (ox-LDL) is a major component of hyperlipidemia and contributes to atherosclerosis. Ox-LDL and ox-LDL-related reactive oxygen species (ROS) and inflammation have deleterious effects on vascular endothelial cells. Previous studies have demonstrated that thioredoxin-1 (Trx) is one of the key regulators of intracellular redox, which may play a role in the pathogenesis of atherosclerosis. This review will summarize the protective mechanisms of Trx on endothelial injury induced by ox-LDL.

Alvaro D. B. Bordalo*

*Consultant in Cardiology (ret.), Preoperative Outpatient Clinic (former Head), Cardio-Thoracic Surgery Department, Hospital de Santa Maria, University of Lisbon School of Medicine, Lisbon, Portugal

HDL complex has multiple functions. There is some parallelism between the plasma HDL-cholesterol (HDL-C) concentrations and the HDL complex atheroprotective function, but those values only measure the reverse C-transport. Multiple epidemiological studies have shown that a high HDL-C level is a strong marker of protection against atherosclerotic vascular disease (AVD) development, but in about 10% of patients, there is no correlation between AVD presence or absence and low or high HDL-C values, respectively. Plasma HDL-C concentrations have multiple genetic determinants, but most of the genetic profiles responsible for the association of high HDL-C levels with atheroprotection are not yet identified. A meta-analysis demonstrated that the HDL capacity of C-acceptance from macrophages is inversely associated with AVD prevalence but is independent of HDL-C values. CETP-inhibition therapies, in spite of up to 133% HDL-C increases, failed to improve AVD secondary prevention. As a consequence, the main focus of research has changed and resides now on attempts to improve HDL complex functionality. Elderly AVD-free aortic stenosis patients represent a natural laboratory terrain for use in studies to identify the HDL complex components responsible for successful atheroprotection. However, the reasons why HDL complex, competent for AVD protection for several decades, fails to prevent aortic sclerosis/calcification in the same patients, remain unknown.

Tobias-Raphael Wenzel¹, Matthias Morfeld^1,2*

¹Institute for Healthcare research, Intervention, Therapy and Evaluation e.V., Stendal, Germany

^*2University of Applied Sciences Magdeburg-Stendal, Rehabilitation Psychology, Stendal, Germany

In Germany, the International Classification of Functioning, Disability and Health (ICF) is anchored in social law and it provides an important theoretical basis for rehabilitative action. Basically, there is an information deficit regarding the use of the ICF in rehabilitative practice in Germany. From the few publications available it can be concluded that the ICF in the practice of medical rehabilitation in Germany is used differently in nature and extent by social insurance agencies and service providers. There is a need for research to better map, support and develop the utilization of the ICF in the practice of medical rehabilitation in Germany.

Ulrich Julius^1*

^*1Lipidology and Center for Extracorporeal Treatment, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany

Ping-Shuan Dong^1*, Jing-Jing Jia¹, Lai-Jing Du¹

^*1Department of Cardiology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China

Various forms of interventional programs have been suggested to help reduce the risk factors for cardiovascular diseases. However, little is known about the effects of physician-based interventional program on the long-term disease prognoses of patients after percutaneous coronary intervention (PCI). A number of studies have demonstrated the intensive secondary prevention provide effective risk factor reduction in coronary artery disease patients, while few studies focused on important cardiovascular outcomes and long-term clinical prognoses. This study is the first prospective randomized controlled study to demonstrate the impact of professional physician-coordinated intensive follow-up on the long-time prognosis of PCI in acute coronary syndrome (ACS) patients in China. We have shown that this intensive follow-up program robustly prolongs the survival time and reduces the controllable risk factors for cardiovascular disease control of cardiovascular risk factors, thereby markedly improve the prognosis of PCI in ACS patients. The study was the first to demonstrate the cost-effect benefit of intensive secondary prevention in ACS patients in Chinese populations, and this benefit was long-term.

Mohsin Khan D.O.^1*, Mitchell S. Karl¹, Ashwin Durairaj¹, and Antonello Santini²

^*1Florida Atlantic University, Schmidt School of Medicine, 777 Glades Road, Boca Raton, FL 33431, United States

²Department of Pharmacy, School of Medicine, University of Napoli Federico II, Via D. Montesano 49, 80131 Napoli, Italy

Martina Mason*, Ian Smith

Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

Obstructive sleep apnoea (OSA) is common and high prevalence has been described amongst patients undergoing cardiac revascularisation surgery. An excess of postoperative complications has been reported in patients with untreated Obstructive Sleep Apnoea (OSA) following surgical procedures, including those undergoing cardiac surgery. This has led some clinicians towards pre-operative screening for OSA though the best screening methodology has not yet been established. Moreover, the effect of screening and of treatment for OSA on surgical outcomes remains unknown. Does current evidence justify screening and treating patients before they present for surgery? Is this leading to potential delay in surgery whilst awaiting sleep diagnostics and commencing the treatment? This review article will examine the available evidence base and endeavour to answer these questions and identify implications for future research.

Alexandar A. Iliev^1*, Georgi N. Kotov¹, Iva N. Dimitrova² and Boycho V. Landzhov¹

¹Department of Anatomy, Histology and Embryology, Medical University of Sofia, Bulgaria

²Department of Cardiology, University Hospital ‘St. Ekaterina’, Medical University of Sofia, Bulgaria

Introduction: Spontaneously hypertensive rats are often used as a model of arterial hypertension in humans. Cardiomyocytic hypertrophy, focal myocytolysis and ventricular fibrosis are only a part of the alterations in the morphology of the myocardium observed in spontaneously hypertensive rats with the progression of hypertension. The present manuscript reviews our studies on spontaneously hypertensive rats, with focus on the microscopic changes in the myocardial architectonics and analysis of several morphometric parameters.

Materials and methods: A total of 12 male spontaneously hypertensive rats, distributed in two age groups, each containing six animals: 1-month-old (young) and 6-months-old (adult) were used. We also used 12 male normotensive Wistar rats, distributed in two age groups, each containing six animals: 1-month-old (young) and 6-months-old (adult). Routine haematoxylin and eosin staining and Mallory’s trichrome stain were conducted. Quantitative data were obtained with a computerized system for image analysis NIS-Elements Advanced Research (Ver. 2.30).

Results: Changes in the normal morphology of the myocardium included cardiomyocytic hypertrophy, focal myocytolysis and ventricular fibrosis. As aging progressed, we noted a significant increase in the thickness of the free wall and cross-sectional area of the cardiomyocytes and the cardiomyocytic nuclei and a decrease in cardiomyocytic density.

Conclusion: The manuscript presents a detailed qualitative and quantitative study of changes in the normal structure of the myocardium initiated by arterial hypertension.

Federico Paredes Vignoli*

Awad Magbri, Eusera El-Magbri, Mariam El-Magbri, Brar Balhinder and Shauket Rashid

Nausica Català Tella^1*, Catalina Serna Arnaiz¹, Jordi Real Gatius^2,3, Oriol Yuguero Torres⁴ and Leonardo Galván Santiago⁵