BackgroundTo investigate the connection between early arterial lactate, arterial bicarbonate ion, lactate/albumin ratio (L/A) and in‐hospital mortality in patients with acute myocardial infarction complicated with cardiac shock (AMICS).MethodsA receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of these indicators for in‐hospital mortality in 395 patients with AMICS. A Kaplan‒Meier survival curve was drawn to analyze the median survival time of each subgroup. A Cox fitted proportional risk model was used to verify the association between these indicators and all‐cause mortality during hospitalization.ResultsROC curve analysis revealed that the areas under the curve for arterial bicarbonate ion level, arterial lactate level, and L/A were 0.707, 0.679, and 0.670, respectively, indicating that these parameters have certain value for predicting in‐hospital mortality in patients with AMICS. The Kaplan‒Meier survival curve revealed that the median survival time of the low bicarbonate ion group was shorter than that of the high bicarbonate ion group, and the median survival time of the low lactic acid group and low L/A group was longer than that of the high lactic acid group and the high L/A group. The Cox proportional risk model indicated that higher arterial bicarbonate ion levels were a protective factor for in‐hospital death in AMICS patients and that higher arterial lactate levels and a higher L/A were independent risk factors.ConclusionEarly arterial bicarbonate ion levels, arterial lactate levels, and the L/A were predictive of all‐cause death in AMICS patients.

BackgroundCardiovascular disease is the leading cause of morbidity and mortality in Indonesia, in which acute myocardial infarction (AMI) has an estimated mortality rate of 9.2%. Heart failure is the most common complication of AMI and increases the risk of death by 3‐4 times. The Killip classification assesses the severity and prognosis of acute new‐onset heart failure (NOHF) in AMI patients: Class I (6% mortality), Class II (17%), Class III (38%), and Class IV (81%). The triglyceride‐glucose (TyG) index, a reliable marker for insulin resistance, is linked to cardiovascular disease pathogenesis. Several studies showed that the TyG index can predict the development of cardiovascular events.AimThis study aims to determine the correlation between TyG index levels and the severity of acute NOHF complications in patients with acute myocardial infarction based on the Killip classification.MethodsThis cross‐sectional analytical observational study involved adult patients with AMI diagnoses in the ER of Dr. Hasan Sadikin Hospital, Bandung, in January–December 2023, who had fasting blood glucose and triglyceride examinations within 72 h of admission and had been assessed with Killip classification. Data analysis was performed using the Spearman test using SPSS software version 25.0.ResultsThis study included 100 AMI patients who met the inclusion and exclusion criteria. Significant relationships were found between comorbidities (diabetes mellitus, hypertension, and smoking) and patient outcomes against Killip classification. Killip Class I had the most improved outcomes (54 patients). Killip Class IV (10 patients) had the most deaths and highest triglycerides and glucose levels. The TyG index showed a strong positive correlation with acute NOHF severity in patients with AMI based on the Killip classification (r = 0.746, p < 0.001).ConclusionThe TyG index has a strong positive correlation with the severity of acute NOHF in patients with acute myocardial infarction based on the Killip classification.

BackgroundCompound dendrobium candidum (CDC) is formulated from Dendrobium candidum and fragrant peony. Preliminary studies have demonstrated that the combination of CDC with conventional antihypertensive medications exhibits significant synergistic effects in lowering blood pressure. The objective of this study was to evaluate the synergistic effect of combining CDC with antihypertensive medications on refractory hypertension in spontaneously hypertensive rats (SHRs) and to elucidate the underlying mechanisms involved.MethodsSHRs were treated with either CDC alone or CDC combined with two or three antihypertensive agents including irbesartan, amlodipine, or terazosin, for a duration of 6 weeks. The alterations in blood pressure, angiotensin II (Ang II), insulin, blood sugar, angiotensin II type I receptor (AT1R), angiotensin II type II receptor (AT2R), insulin receptor, insulin α receptor, and insulin β receptor levels were assessed. Glomerular endothelial cells from refractory SHR were then taken for overexpression and knockdown of AT2R gene and co‐cultured with CDC serum to measure the expression levels of Ang II receptor gene and protein.ResultsIn comparison to the findings observed in the irbesartan + amlodipine + terazosin (IAT) group, the addition of CDC significantly enhanced antihypertensive efficacy. The rate of achieving blood pressure targets (< 150 mmHg) in SHRs with refractory hypertension increased from 0% to 100%. Treatment with CDC significantly reduced the compensatory increase in AT1R and AT2R levels caused by IAT treatment and showed a significant antihypertensive and synergistic effect. Primary glomerular endothelial cells extracted from SHRs and Wistar rats and treated with 0.5% CDC‐containing serum showed significantly reduced AT2R levels in the AT2R‐overexpression condition. The combination of CDC and antihypertensive drugs was effective in reducing the messenger RNA (mRNA) and protein expression levels of AT1R and AT2R in glomerular endothelial cells.ConclusionsCDC in combination with antihypertensive drugs showed a synergistic effect in controlling refractory hypertension. The mechanism of action may be related to the attenuation of excessive expression of AT2R. This study offers a novel approach for the treatment of clinically resistant hypertension.

Remimazolam, an ultra-short-acting benzodiazepine with rapid metabolism and cardiovascular stability, is increasingly used for anesthesia, yet its cardiac electrophysiologic effects are incompletely characterized. We conducted a multimodal evaluation in Langendorff-perfused guinea pig hearts and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), using surface electrocardiogram (ECG), multielectrode mapping, optical mapping, and whole-cell patch-clamp across remimazolam doses (0, 1, 2, 3 mg/kg/h). High-dose remimazolam (3 mg/kg/h) prolonged the PR interval (p = 0.027), and T-wave duration was prolonged at 2 and 3 mg/kg/h (p = 0.017 and p < 0.001), while QT interval and corrected QT interval (QTc) remained unchanged (p > 0.1). Multielectrode mapping showed prolonged activation time at 2 and 3 mg/kg/h versus NC (p = 0.02 and 0.003) and increased conduction dispersion at 2 and 3 mg/kg/h (p = 0.0193 and 0.0101). Conduction velocity (CV) was reduced at 3 mg/kg/h compared with NC and 1 mg/kg/h (p = 0.01 and 0.02). Optical mapping demonstrated prolonged action potential duration at 90% repolarization (APD90) (NC: 107.93 ± 0.63 ms vs 3 mg/kg/h: 118.94 ± 1.83 ms, p < 0.001) and calcium transient duration at 90% recovery (CTD90) (NC: 116.20 ± 1.04 ms vs 3 mg/kg/h: 125.63 ± 1.15 ms, p < 0.001), accompanied by increased APD90 interquartile range (APD90-IQR; p ≤ 0.02 vs NC) and increased CTD90 interquartile range (CTD90-IQR; p = 0.005). In hiPSC-CMs, 1500 ng/mL remimazolam selectively prolonged APD90 (p = 0.04) without significant effects on action potential amplitude, upstroke velocity, or early repolarization indices (all p > 0.05). These findings indicate that at higher clinically relevant exposures, remimazolam selectively lengthens late repolarization and increases conduction heterogeneity-features consistent with an arrhythmogenic substrate-while QT and QTc remains stable, supporting cautious use and ECG monitoring in at-risk populations.

[This corrects the article DOI: 10.1155/crp/9970541.].

Background: Bioresorbable coronary stents (BRS) were designed with the aim of reducing the risk of late adverse events of permanent drug-eluting stents (DES) by dissolving once vessel patency had been restored and the requirement for acute mechanical support resolved. Bioresorbable poly-L-lactic acid (PLLA) scaffold designs, while initially appearing as promising technology, were unsuccessful in widespread clinical use due to an observed high rate of late stent thrombosis. Magnesium-based BRS (MgBRS) have provided an alternative to this original design and have shown promise in early-phase clinical trials. This review aims to address the clinical question: How does the current safety and efficacy evidence for MgBRS in all patients requiring percutaneous coronary intervention compare with the randomised data assessing PLLA-BRS and contemporary DES?Methods: Two parallel systematic reviews were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilising MEDLINE, EMBASE and Web of Science: the first assessing clinical outcomes of all observational and randomised MgBRS trials, the second assessing clinical outcomes of PLLA-BRS versus DES in randomised clinical trials. The primary safety and efficacy outcomes collected were cardiac death, target vessel failure (TVF) and stent thrombosis.Results: A total of 3582 MgBRS patients (24 trials), 6370 PLLA-BRS and 5413 DES patients (16 trials) were included for analysis. Cardiac death was similar across all three stent designs in all time intervals. MgBRS performed similarly to contemporary DES and superiorly to PLLA-BRS at 12- and 24-month intervals with regard to TVF and stent thrombosis. Longer follow-up was suggestive of a poorer performance of MgBRS relative to DES, although with limited patient numbers.Conclusion: MgBRS appear to perform similarly to DES and superiorly to PLLA-BRS at 12 and 24 months in regard to key clinical safety and efficacy measures. Further randomised studies are required before recommending this technology for widespread clinical use over DES.

Objectives: The head-up tilt test (HUTT) is a well-established diagnostic procedure used to differentiate between the types of syncope. Since its introduction in 1986, the protocol has undergone several refinements aimed at increasing diagnostic accuracy. Despite growing interest in advanced autonomic ECG parameters and beat-to-beat blood pressure monitoring, their integration into routine HUTT protocols remains limited. Methods: In this study, we compared the conventional HUTT protocol using two-minute interval monitoring with an advanced protocol incorporating autonomic ECG parameters-periodic repolarization dynamics (PRD) and deceleration capacity (DC)-as well as continuous beat-to-beat hemodynamic monitoring. Results: The extended protocol improves diagnostic resolution by detecting more pronounced hemodynamic fluctuations, enabling real-time trend analysis, and allowing earlier recognition of impending syncope. The tilt phase was characterized by a significant initial increase in PRD, and patients with syncope showed significantly higher PRD values during the tilt phase (8.14 vs. 3.91 deg2, p=0.043). Conclusions: Continuous hemodynamic monitoring during HUTT improves the diagnostic quality by detecting changes at an early stage, thus allowing to anticipate syncope and to clearly identify its etiology. While beat-to-beat blood pressure monitoring is already recommended by current syncope guidelines, we propose the additional evaluation of autonomic ECG parameters as a valuable extension to standard protocols.

IntroductionTransducin beta‐like 1 X‐linked receptor 1 (TBL1XR1) is significantly upregulated in the peripheral blood of patients with coronary artery disease (CAD). This study aimed to validate the differential expression of TBL1XR1 in CAD and investigate its role in CAD progression using RNA interference.MethodsThe expression of TBL1XR1 at the mRNA and protein levels was detected in patients with CAD and controls using reverse transcription–polymerase chain reaction (RT–PCR) and western blotting. Additionally, the effects of TBL1XR1 gene silencing in human liver cells through RNA interference on PPARα expression and intracellular triglyceride (TG) levels were determined.ResultsTBL1XR1 expression was significantly higher in the peripheral blood of CAD patients compared to controls at both mRNA (1.71 ± 0.96 vs. 1.00 ± 0.34, p < 0.01) and protein levels (0.41 ± 0.19 vs. 0.13 ± 0.07, p = 0.038). Logistic regression analysis revealed that high TBL1XR1 expression is an independent risk factor for CAD. Relative TBL1XR1 expression positively correlated with serum TG levels (rs = 0.56, p < 0.01) and Gensini score (rs = 0.53, p < 0.01), indicating an association with CAD severity. In human liver cells, TBL1XR1 silencing significantly increased peroxisome proliferator‐activated receptor alpha (PPARα) expression at both mRNA (p < 0.05) and protein levels (p < 0.01) while reducing intracellular TG levels (0.24 ± 0.16 vs. 0.51 ± 0.09, p < 0.01).ConclusionTBL1XR1 is a key factor for risk assessment, diagnosis, and evaluating coronary lesion severity in patients with CAD. Its role in promoting atherosclerosis initiation and development may be associated with regulation of TG metabolism via the PPARα pathway.

PurposeMitochondrial biogenesis is an important factor affecting the development of acute myocardial infarction. MAP/MARK4, a member of the MAP serine/threonine kinase (MARK) family, is involved in a variety of physiological processes. The aim of this study was to investigate the role of microtubule affinity‐regulating kinase 4 (MARK4) in regulating mitochondrial biogenesis in rats with myocardial infarction.MethodsOne week after the left anterior descending, coronary artery was ligated to establish a myocardial infarction model, and MARK4 expression was knocked down in mice. In the fifth week, changes in cardiac function and structure, the myocardial BNP and ATP content, mitochondrial ultrastructure, and the mitochondrial membrane potential and reactive oxygen species levels were observed and detected, and the levels of AMPKα and mitochondrial biogenesis- and apoptosis-related proteins were detected using western blot analysis.ResultsWe found that downregulating the expression of MARK4 in rats with myocardial infarction improved cardiac function, alleviated cardiac pathological injury and restored damaged mitochondrial membrane potential, effectively inhibited myocardial apoptosis and restored the myocardial energy supply, and promoted mitochondrial biosynthesis by increasing AMPKα phosphorylation. However, the addition of an AMPKα inhibitor after MARK4 knockdown did not affect mitochondrial biosynthesis in cardiomyocytes, indicating that the inhibition of MARK4 expression may be a promising therapeutic target for myocardial infarction.ConclusionInhibition of MARK4 expression in rats with myocardial infarction plays a cardioprotective role and promotes mitochondrial biogenesis by promoting AMPKα phosphorylation.

BackgroundDetermining the normal ranges of the aortic dimension is essential in various populations. In this study, we aim to define the normal ranges for the sinus of Valsalva (SoV), the sinotubular junction (STJ), and the ascending aorta (AA) diameters using the Imam Khomeini Hospital Complex (IKHC) data registry of Iranian adults.MethodsThis study was conducted on 2269 adult participants with left ventricular ejection fraction (LVEF) of more than 50%. Echocardiographic measurements were taken at the SoV, STJ, and AA levels. Subjects with any valvular stenosis and more than moderate insufficiency were excluded.ResultsThe normal range of SoV was found to be 24.5–38.9 mm in males and 21.7–34.9 mm in females. Additionally, the STJ diameters ranged from 19.7 to 32.5 mm and 18.0 to 29.6 mm in males and females, respectively. The AA measurements showed significant differences between sexes, ranging from 23.74 to 38.02 mm in males and 21.45 to 36.53 mm in females. Results also indicated that for every 10-year increase in age, the diameters of SoV, STJ, and AA increased by approximately 1.0, 0.8, and 1.6 mm, respectively.ConclusionThis study provided detailed echocardiographic reference values for aortic dimensions in the Iranian population and compared them across various age groups, genders, and body mass index (BMI) categories. Also, the findings emphasize the impact of aging on aortic values. The limited external validity of our single-center, hospital-based study suggests that future multicenter research is necessary to confirm our findings and improve their generalizability.