Heart failure (HF) is a clinical syndrome characterized by the inability of the heart to provide adequate perfusion to tissues and organs, resulting in typical symptoms such as fatigue, dyspnea, dyspepsia, or swelling due to decreased cardiac output. With its increasing prevalence, heart failure has become one of the leading causes of morbidity and mortality worldwide, imposing a significant burden on the population by reducing long-term life expectancy and raising hospital costs. Indeed, over 20 million people worldwide suffer from heart failure, with a 5-year mortality rate of 60-70%. As heart failure progresses, various structural and metabolic changes occur within the myocardium and organ systems. In the past two decades, therapeutic options for heart failure patients have significantly expanded. In addition to novel pharmacological treatment, advanced surgical methods such as heart transplantation (HTx) and the implantation of durable left ventricular assist devices (LVADs) are available for patients with end-stage heart failure. This review discusses the pathophysiological aspects and metabolic consequences of heart failure and metabolic changes, as well as the benefits and challenges of implanting a left ventricular assist device. Furthermore, future targets for heart failure diagnostics and therapy will be highlighted.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) are glucose-lowering agents used for the treatment of type 2 diabetes mellitus, which also improve heart failure and decrease the risk of cardiovascular complications. Epicardial adipose tissue (EAT) dysfunction was suggested to contribute to the development of heart failure. We aimed to elucidate a possible role of changes in EAT metabolic and inflammatory profile in the beneficial cardioprotective effects of SGLT-2i in subjects with severe heart failure. METHODS: 26 subjects with severe heart failure, with reduced ejection fraction, treated with SGLT-2i versus 26 subjects without treatment, matched for age (54.0 ± 2.1 vs. 55.3 ± 2.1 years, n.s.), body mass index (27.8 ± 0.9 vs. 28.8 ± 1.0 kg/m2, n.s.) and left ventricular ejection fraction (20.7 ± 0.5 vs. 23.2 ± 1.7%, n.s.), who were scheduled for heart transplantation or mechanical support implantation, were included in the study. A complex metabolomic and gene expression analysis of EAT obtained during surgery was performed. RESULTS: SGLT-2i ameliorated inflammation, as evidenced by the improved gene expression profile of pro-inflammatory genes in adipose tissue and decreased infiltration of immune cells into EAT. Enrichment of ether lipids with oleic acid noted on metabolomic analysis suggests a reduced disposition to ferroptosis, potentially further contributing to decreased oxidative stress in EAT of SGLT-2i treated subjects. CONCLUSIONS: Our results show decreased inflammation in EAT of patients with severe heart failure treated by SGLT-2i, as compared to patients with heart failure without this therapy. Modulation of EAT inflammatory and metabolic status could represent a novel mechanism behind SGLT-2i-associated cardioprotective effects in patients with heart failure.
- MeSH
- antiflogistika terapeutické užití farmakologie MeSH
- biologické markery krev MeSH
- diabetes mellitus 2. typu farmakoterapie metabolismus diagnóza MeSH
- epikardiální adipózní tkáň MeSH
- funkce levé komory srdeční účinky léků MeSH
- glifloziny * terapeutické užití farmakologie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mediátory zánětu * metabolismus MeSH
- metabolomika MeSH
- perikard * metabolismus účinky léků MeSH
- srdeční selhání * metabolismus patofyziologie farmakoterapie MeSH
- stupeň závažnosti nemoci * MeSH
- tepový objem účinky léků MeSH
- tuková tkáň * účinky léků metabolismus MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
(1) Background: C1q TNF-related protein 3 (CTRP3) is an adipokine with anti-inflammatory and cardioprotective properties. In our study, we explored changes in serum CTRP3 and its gene expression in epicardial (EAT) and subcutaneous (SAT) adipose tissue in patients with and without coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) undergoing elective cardiac surgery. (2) Methods: SAT, EAT, and blood samples were collected at the start and end of surgery from 34 patients: (i) 11 without CAD or T2DM, (ii) 14 with CAD and without T2DM, and (iii) 9 with both CAD and T2DM. mRNA levels of CTRP3 were assessed by quantitative reverse transcription PCR. Circulating levels of CTRP3 and other factors were measured using ELISA and Luminex Multiplex commercial kits. (3) Results: Baseline plasma levels of TNF-α and IL6 did not differ among the groups and increased at the end of surgery. Baseline circulating levels of CTRP3 did not differ among the groups and decreased after surgery. In contrast, baseline CTRP3 mRNA levels in EAT were significantly decreased in CAD/T2DM group, while no differences were found for TNF-α and IL6 gene expression. (4) Conclusions: Our data suggest that decreased EAT mRNA levels of CTRP3 could contribute to higher risk of atherosclerosis in patients with CAD and T2DM.
- MeSH
- diabetes mellitus 2. typu * komplikace genetika chirurgie MeSH
- interleukin-6 metabolismus MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- messenger RNA metabolismus MeSH
- nemoci koronárních tepen * komplikace genetika chirurgie MeSH
- perikard metabolismus MeSH
- TNF-alfa genetika metabolismus MeSH
- tuková tkáň metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE OF THE STUDY To compare the outcomes of parallel and convergent iliosacral screw insertion into the body of vertebra S1 in the treatment of posterior pelvic arch injuries. MATERIAL AND METHODS Radiographs of 120 patients (43 women, 77 men), aged between 14-79 years, treated with iliosacral screw fixation for posterior pelvic ring fractures between 1.1.2009 and 31.12.2019 were reviewed for inclusion in the study. In each case two screws were inserted into the body of vertebra S1. The screws were inserted in either parallel or convergent orientation. Convergent orientation allows the threads of both screws to be interconnected. In this technique, the first screw is inserted into the centre of the body of vertebra S1 as a compression screw. The second screw is inserted as a positioning screw and is placed so that the threads of both screws lock together. We believe that the interlocking of the threads of both screws and contact of the second screw with three cortices (two of the iliac bone and one of the sacrum) increase the stability of the fixation. Migration of loosened screws was measured on radiographs of the pelvis obtained at six weeks and at three, six and twelve months postoperatively. Migration of five millimetres or more within the first six weeks was considered to be clinically significant. Only patients after primary fracture treatment and with a complete one-year follow-up were included in the study. Cases of non-union and failure of osteosynthesis of the anterior pelvic arch and patients with incomplete follow-up were excluded. The incidence of significant screw migration between the two techniques was compared using Fisher's exact test with a 5% level of significance. RESULTS Sixty-three patients (23 women, 40 men) aged 17 to 79 years were included in the study. Parallel screws were used in 24 patients (8 women, 16 men) and convergent screws were used in 39 patients (15 women, 24 men). Clinically significant migration occurred in nine (38%) patients after parallel insertions. In two of these cases there was unstable fixation of the anterior pelvic arch. Migration of convergently placed iliosacral screws occurred in four (10%) cases. In three of these cases this was due to unstable fixation of the anterior pelvic arch. The difference in screw migration between the two groups was shown to be significant (p = 0.0219). DISCUSSION Iliosacral screws ensure sufficient stability of the posterior arch in type B and C pelvic fractures provided that the anterior pelvic arch is stable. Convergent insertion of iliosacral screws may increase the stability of fixation. Minimally invasive surgery with sufficient stability may be advantageous for early treatment of patients after multiple trauma and in elderly patients. The weaknesses of this study are its relatively small number of patients, which prevented reliable statistical analysis of screw migration according to the type of pelvic fractures. The second main limitation is the failure to perform densitometric examination of the skeleton in patients with X-ray proven screw migration for confirmation of osteoporosis as one of the possible causes of fixation failure. CONCLUSIONS The results of the study suggest that convergent insertion of iliosacral screws into S1 is associated with a lower risk of screw migration and subsequent failure of fixation of the posterior pelvic arch. Key words: pelvic fracture, pelvic injury, iliosacral screw, parallel screws, convergent screws, migration of iliosacral screws.
- MeSH
- dospělí MeSH
- fraktury kostí * chirurgie MeSH
- kostní šrouby škodlivé účinky MeSH
- křížová kost diagnostické zobrazování zranění chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pánevní kosti * zranění MeSH
- senioři MeSH
- vnitřní fixace fraktury škodlivé účinky metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Pacienti s implantovanou levostrannou mechanickou srdeční podporou (LVAD) jsou vystaveni zvýšenému počtu klinických komplikací. Jednou z možných příčin může být nepulzatilní tok krve generovaný mechanickou srdeční podporou. Cílem naší práce proto bylo zhodnotit vliv změn toku krve v karotickém řečišti a zvýšené tuhosti tepen na mortalitu a výskyt cévních mozkových příhod u pacientů s LVAD. Metody: Postupně jsme analyzovali data 83 pacientů s LVAD (průměrný věk 54 ± 15 let, 12 žen, HeartMate II (HMII), n = 34; HeartMate 3 (HM3) n = 49. V časových intervalech 3 a 6 měsíců po implantaci LVAD jsme hodnotili pulzatilní index, index rezistence a aterosklerotické změny v karotickém řečišti (měřeno pomocí ultrazvuku) a tuhost tepen (měřeno pomocí přístroje Endo-PAT 2000 s augmentačním indexem standardizovaným k srdečnímu tepu – AI@75). Výsledky: 16 pacientů zemřelo během doby sledování (27,3 měsíců, IQR 15,7–44,3). Po standardizace na hlavní zkoumané proměnné byla u pulzatilního indexu měřeného ve 3 měsících po implantaci zjištěna výrazná pozitivní asociace s úmrtími a cévními mozkovými příhodami (HR 9,8, 95% CI 1,6–59,4), která dále výrazně zesílila zohledněním AI@75 (HR 18,8, 95% CI 2,4–145,5). Dále bylo u pacientů s HM3 riziko úmrtí a cévních mozkových příhod výrazně nižší než u pacientů s HMII (HR 0,31, 95% CI 0,1–0,9), tento vztah však byl výrazně oslaben zohledněním AI@75 (HR 0,33, 95% CI 0,1–1,2). Závěr: Riziko úmrtí nebo cévních mozkových příhod u pacientů s LVAD je asociováno se zvýšeným pulzatilním indexem v karotických tepnách a dále potencováno zvýšenou tuhostí tepen. Stejné riziko je sníženo implantací HM3 ve srovnání s HMII, ale tento rozdíl je zvýšenou arteriální tuhostí oslaben
- Publikační typ
- abstrakt z konference MeSH
AIMS: Recipients of left ventricular assist devices (LVAD) are exposed to increased risk of adverse clinical events. One of the potential contributing factors is non-pulsatile flow generated by LVAD. We evaluated the association of flow patterns in carotid arteries and of increased arterial stiffness with death and cerebrovascular events in LVAD recipients. METHODS AND RESULTS: We analysed data from 83 patients [mean age 54 ± 15 years; 12 women; HeartMate II (HMII), n = 34; HeartMate 3 (HM3), n = 49]. Pulsatile and resistive indexes, atherosclerotic changes in carotid arteries (measured by duplex ultrasound), and arterial stiffness [measured by Endo-PAT 2000 as the augmentation index standardized for heart rate (AI@75)] were evaluated 3 and 6 months after LVAD implantation. Sixteen patients died during follow-up (27.3 months; interquartile range 15.7-44.3). After adjusting for the main variables examined, the pulsatility index measured at 3 months was positively associated with increased hazard ratios (HR) for death and cerebrovascular events [HR 9.8, 95% confidence interval (CI) 1.62-59.42], with HR increasing after adding AI@75 to the model (HR 18.8, 95% CI 2.44-145.50). In HM3 recipients, HR was significantly lower than in HMII recipients (HR 0.31, 95% CI 0.11-0.91), but the significance disappeared after adding AI@75 to the model (HR 0.33, 95% CI 0.09-1.18). CONCLUSIONS: The risk of death and cerebrovascular events in LVAD recipients is associated with increased pulsatility index in carotid arteries and potentiated by increased arterial stiffness. The same risk is attenuated by HM3 LVAD implantation, but this effect is weakened by increased arterial stiffness.
- MeSH
- ateroskleróza * MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- senioři MeSH
- srdeční selhání * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Ventricular septal defect (VSD) is a severe complication of myocardial infarction (MI) with a high mortality rate. We report a case of a large post-MI VSD treated with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO) to restore hemodynamic stability and to avoid surgery in the acute setting. VSD closure with endoventricular patch and implantation of biventricular assist device (BiVAD) was arranged sixteen days after MI. Because of no signs of myocardial recovery, implantation of durable left ventricular assist device (LVAD) as a bridge to transplant was provided, leaving right ventricular assist device (RVAD) to right ventricle recovery. RVAD was explanted 18 days after durable LVAD placement and the patient was discharged home two months after MI. The use of durable LVAD is a unique solution that can be applied in selected patients with MI-VSD and heart failure.
