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Medicina
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New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention...
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New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 11414

Special Issue Editors

Dr. Meng-Yu Wu

E-Mail Website1 Website2 Website3
Guest Editor
Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
Interests: trauma; shock; prehospital care; critical care; infection control
Special Issues, Collections and Topics in MDPI journals
Dr. Jui-Yuan Chung

E-Mail
Guest Editor
1. Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
2. School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
3. School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
Interests: prehospital care; ultrasound; emergency medicine; resuscitation; trauma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Ischemic heart diseases (IHD) remain a leading cause of mortality worldwide. Myocardial ischemia is the fundamental substrate of acute and chronic coronary syndromes. Early diagnosis of myocardial ischemia in the complex comorbidities is a challenge for the clinician. Atypical symptoms and unclear paraclinical data from ECG, biomarkers, stress test, invasive and non-invasive imaging procedures are not easy to establish a correct diagnosis. In addition, the high incidence and severe prognosis of IHD highlight the need for novel research in the field to optimize diagnosis and treatment to improve the clinical outcomes. Therefore, in this special issue, we aim to form a team of specialists whose advanced experience in IHD, from not only in the complex mechanisms of the relationship between myocardial ischemia and various pathologies, to real world data. Therefore, we invite you to share your experience and researches thus help to identify the best diagnostic and therapeutic solutions for IHD population.

Dr. Meng-Yu Wu
Dr. Jui-Yuan Chung
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronary artery disease
  • heart failure
  • cardiovascular risk factor
  • comorbidities
  • prevention
  • hypertension
  • cardiovascular medicine
  • treatment
  • big data analysis
  • real world data

Published Papers (6 papers)

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Research

14 pages, 2891 KiB  
Article
Changes in Left Ventricular Ejection Fraction and Oxidative Stress after Phosphodiesterase Type-5 Inhibitor Treatment in an Experimental Model of Retrograde Rat Perfusion
by Milos Krivokapic, Israpil Alisultanovich Omarov, Vladimir Zivkovic, Tamara Nikolic Turnic and Vladimir Jakovljevic
Medicina 2023, 59(3), 458; https://doi.org/10.3390/medicina59030458 - 24 Feb 2023
Viewed by 1285
Abstract
Background and objectives: Taking into consideration the confirmed role of oxidative stress in ischemia/reperfusion injury and the insufficiency in knowledge regarding the phosphodiesterase 5 (PDE5)-mediated effects on the cardiovascular system, the aim of our study was to investigate the influence of two [...] Read more.
Background and objectives: Taking into consideration the confirmed role of oxidative stress in ischemia/reperfusion injury and the insufficiency in knowledge regarding the phosphodiesterase 5 (PDE5)-mediated effects on the cardiovascular system, the aim of our study was to investigate the influence of two PDE5 inhibitors, tadalafil and vardenafil, with or without the addition of N(G)-nitro-L-arginine methyl ester (L-NAME), on oxidative stress markers, coronary flow and left ventricular function, both ex vivo and in vivo. Methods: This study included 74 male Wistar albino rats divided into two groups. In the first, 24 male Wistar rats were orally treated with tadalafil or vardenafil for four weeks in order to perform in vivo experiments. In the second, the hearts of 50 male Wistar albino were excised and perfused according to the Langendorff technique in order to perform ex vivo experiments. The hearts were perfused with tadalafil (10, 20, 50 and 200 nM), vardenafil (10, 20, 50 and 200 nM) and a combination of tadalafil/vardenafil and L-NAME (30 μM). The CF and oxidative stress markers, including nitrite bioaviability (NO2−), superoxide anion radical (O2−), and the index of lipid peroxidation, were measured in coronary effluent. Results: The L-arginin/NO system acts as the mediator in the tadalafil-induced effects on the cardiovascular system, while it seems that the vardenafil-induced increase in CF was not primarily induced by the NO system. Although tadalafil induced an increase in O2− in the two lowest doses, the general effects of both of the applied PDE5 inhibitors on oxidative stress were not significant. The ejection function was above 50% in both groups. Conclusions: Our results showed that both tadalafil and vardenafil improved the coronary perfusion of the myocardium and LV function by increasing the EF. Full article
(This article belongs to the Special Issue New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies)
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10 pages, 1216 KiB  
Article
Prognostic Implication of Small Dense LDL-Cholesterol Levels following Acute Coronary Syndrome
by Teruhiko Imamura, Masakazu Hori, Nikhil Narang, Hiroshi Ueno and Koichiro Kinugawa
Medicina 2023, 59(1), 158; https://doi.org/10.3390/medicina59010158 - 12 Jan 2023
Cited by 2 | Viewed by 1985
Abstract
Background and Objectives: Small dense LDL cholesterol is a strong risk factor for atherosclerosis. However, few studies have investigated the impacts of this specific lipid profile on the incident risk of adverse cardiovascular events in patients with acute coronary syndrome. Materials and [...] Read more.
Background and Objectives: Small dense LDL cholesterol is a strong risk factor for atherosclerosis. However, few studies have investigated the impacts of this specific lipid profile on the incident risk of adverse cardiovascular events in patients with acute coronary syndrome. Materials and Methods: Patients with acute coronary syndrome, who underwent revascularization, were included and followed for 2 years. The levels of small dense LDL cholesterol were measured at index discharge (day 0) in the setting of newly administered therapies for secondary prevention, including aspirin and statins, during the index hospitalization. The prognostic impact of small dense LDL-cholesterol levels on the risk of a primary composite endpoint, including cardiac death, non-fatal myocardial infarction, unstable angina pectoris, stroke, and heart failure, was investigated. Results: In total, 46 patients (median 75 (59, 83) years old, 63% men) were included. Median small dense LDL cholesterol was 19.4 (13.5, 23.8) mg/dL at index discharge. All patients initiated statin treatment before the index discharge, with a median LDL-cholesterol level of 77 (64, 109) mg/dL. Small dense LDL-cholesterol level was independently associated with an incremental risk for the primary endpoint (p < 0.05 by adjusting for several potential risk factors, including LDL cholesterol) with a cutoff of 32.6 mg/dL. Conclusions: Small dense LDL-cholesterol level was a significant risk factor for cardiovascular events following presentations of acute coronary syndrome. Full article
(This article belongs to the Special Issue New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies)
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8 pages, 675 KiB  
Article
Systemic Endothelial Function, Plasma Xanthine Oxidoreductase Activity, and Blood Pressure Variability in Patients with Stable Coronary Artery Disease
by Takashi Hiraga, Yuichi Saito, Kazuya Tateishi, Naoto Mori, Takayo Murase, Takashi Nakamura, Seigo Akari, Kan Saito, Hideki Kitahara and Yoshio Kobayashi
Medicina 2022, 58(10), 1423; https://doi.org/10.3390/medicina58101423 - 10 Oct 2022
Viewed by 1381
Abstract
Background and Objectives: Although previous studies showed that an activity of xanthine oxidoreductase (XOR), a rate-limiting enzyme in purine metabolism, beyond the serum uric acid level, was associated with the development of coronary artery disease (CAD), the underlying mechanisms are unclear. Because endothelial [...] Read more.
Background and Objectives: Although previous studies showed that an activity of xanthine oxidoreductase (XOR), a rate-limiting enzyme in purine metabolism, beyond the serum uric acid level, was associated with the development of coronary artery disease (CAD), the underlying mechanisms are unclear. Because endothelial dysfunction and a greater blood pressure (BP) variability may play a role, we investigated the relations among the endothelial function, XOR, and BP variability. Materials and Methods: This was a post-hoc study using pooled data of patients with a stable CAD from two prospective investigations, in which the systemic endothelial function was assessed with the reactive hyperemia index (RHI) and the XOR activity was measured. The BP variability was evaluated using BP measurements during the three- and four-day hospitalization. Results: A total of 106 patients with a stable CAD undergoing a percutaneous coronary intervention were included. Of the 106 patients, 46 (43.4%) had a systemic endothelial dysfunction (RHI < 1.67). The multivariable analysis identified a higher body mass index (BMI), female gender, and diabetes as factors associated with an endothelial dysfunction. A higher BMI was also related to an elevated XOR activity, in addition to current smoking. No significant correlation was observed between the RHI and XOR activity. Similarly, the in-hospital BP variability was associated with neither the endothelial function nor XOR. Conclusions: Among patients with a stable CAD, several factors were identified as being associated with a systemic endothelial dysfunction or an elevated XOR activity. However, no direct relations between the endothelial function, XOR, and BP variability were found. Full article
(This article belongs to the Special Issue New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies)
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11 pages, 838 KiB  
Article
Factors Responsible for Prehospital Delay in Patients with Acute Coronary Syndrome in Bangladesh
by Md. Fakhrul Islam Khaled, Dipal Krishna Adhikary, Md. Mazharul Islam, Md. Mashiul Alam, Mohammad Walidur Rahman, MSI Tipu Chowdhury, Roseyat Perveen, Sharmin Ahmed, Eshita Ashab, Shiblee Sadeque Shakil, Sanjida Ansari, Bikash Chandra Das, Noor Mohammad, Mohammad Abul Ehsan, Abu Baqar Md. Jamil, Zahidul Mostafa, Zainal Abedin and Sajal Krishna Banerjee
Medicina 2022, 58(9), 1206; https://doi.org/10.3390/medicina58091206 - 2 Sep 2022
Cited by 2 | Viewed by 2466
Abstract
Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the [...] Read more.
Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the onset of myocardial ischemia/infarction symptoms and arrival at the hospital, where either pharmacological or interventional revascularization is available. This delay remains unacceptably long in many countries worldwide, including Bangladesh. The current study investigates several sociodemographic characteristics as well as clinical, social, and treatment-seeking behaviors, with an aim to uncover the factors responsible for the decision time to get medical help and home-to-hospital delay. Materials and Methods: A prospective cross-sectional study was conducted between July 2019 and June 2020 in 21 district hospitals and 6 medical college hospitals where cardiac care facilities were available. The population selected for this study was patients with ACS who visited the studied hospitals during the study period. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and was subsequently analyzed. Results: This study evaluated 678 ACS patients from 30 districts. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40–60 years of age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients received their first medical care after 12 h of first symptom presentation. The study found that the patients’ age, residence, education, and employment status were significant factors associated with prehospital delay. The patients with previous myocardial infarction (MI) and chest pain arrived significantly earlier at the hospital following ACS onset. Location of symptom onset, first medical contact with a private physician, distance from symptom onset location to location of first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transportation were significantly associated with prehospital delay. Conclusions: Several factors of prehospital delay of the ACS patients in Bangladesh have been described in this study. The findings of this study may help the national health management system identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity and mortality. Full article
(This article belongs to the Special Issue New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies)
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Graphical abstract

10 pages, 832 KiB  
Article
Impact of Alirocumab on Release Markers of Atherosclerotic Plaque Vulnerability in Patients with Mixed Hyperlipidemia and Vulnerable Atherosclerotic Plaque
by Michał Kosowski, Marcin Basiak, Marcin Hachuła and Bogusław Okopień
Medicina 2022, 58(7), 969; https://doi.org/10.3390/medicina58070969 - 21 Jul 2022
Cited by 5 | Viewed by 1694
Abstract
Background and Objectives: Atherosclerosis is a disease in the pathogenesis of which plasma factors apart from elevated cholesterol levels play a keyrole. Such factors include osteopontin (OPN), osteoprotegerin (OPG), and metalloproteinases (MMPs), which are factors that may be responsible for the stabilization [...] Read more.
Background and Objectives: Atherosclerosis is a disease in the pathogenesis of which plasma factors apart from elevated cholesterol levels play a keyrole. Such factors include osteopontin (OPN), osteoprotegerin (OPG), and metalloproteinases (MMPs), which are factors that may be responsible for the stabilization of atherosclerotic plaque. The aim of this study was to assess the effect of modern lipid-lowering therapy by using proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitor on the concentrations of these factors. Materials and Methods: The study included people suffering from dyslipidemia who were eligible to start alirocumab therapy. In this group, the concentrations of OPN, OPG, and MMPs were assessed before the initiation of therapy and after three months of its duration. Results: In the study, we observed a statistically significant reduction in the concentrations of OPN, OPG (p < 0.001), and metalloproteinase 2 (MMP-2) (p < 0.05) after the applied therapy. Moreover, we noticed that in the group of patients soon to start alirocumab therapy, the concentrations of these factors were higher compared to the control group (p < 0.001). Conclusions: The results of our study show that therapy with alirocumab significantly reduces the concentration of factors that affect atherosclerotic plaque vulnerability, which may explain their important role in reducing cardiovascular risk in patients undergoing this therapy. Full article
(This article belongs to the Special Issue New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies)
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11 pages, 790 KiB  
Article
Underestimated Ischemic Heart Disease in Major Adverse Cardiovascular Events after Septicemia Discharge
by Chih-Chun Hsiao, Yao-Ming Huang, Yin-Han Chang, Hui-Chen Lin, Wu-Chien Chien, Chun-Gu Cheng and Chun-An Cheng
Medicina 2022, 58(6), 753; https://doi.org/10.3390/medicina58060753 - 31 May 2022
Cited by 1 | Viewed by 1899
Abstract
Background and Objectives: Sepsis increases cardiovascular disease and causes death. Ischemic heart disease (IHD) without acute myocardial infarction has been discussed less, and the relationship between risk factors and IHD in septicemia survivors within six months is worthy of in-depth study. Our [...] Read more.
Background and Objectives: Sepsis increases cardiovascular disease and causes death. Ischemic heart disease (IHD) without acute myocardial infarction has been discussed less, and the relationship between risk factors and IHD in septicemia survivors within six months is worthy of in-depth study. Our study demonstrated the incidence of IHD and the possible risk factors for IHD in septicemia patients within six months. Materials and Methods: An inpatient dataset of the Taiwanese Longitudinal Health Insurance Database between 2001 and 2003 was used. The events were defined as rehospitalization of stroke and IHD after discharge or death within six months after the first septicemia hospitalization. The relative factors of major adverse cardiovascular events (MACEs) and IHD were identified by multivariate Cox proportional regression. Results: There were 4323 septicemia survivors and 404 (9.3%) IHD. New-onset atrial fibrillation had a hazard ratio (HR) of 1.705 (95% confidence interval (C.I.): 1.156–2.516) for MACEs and carried a 184% risk with HR 2.836 (95% C.I.: 1.725–4.665) for IHD by adjusted area and other risk factors. Conclusions: This study explored advanced-aged patients who experienced more severe septicemia with new-onset atrial fibrillation, which increases the incidence of IHD in MACEs within six months of septicemia. Therefore, healthcare providers must identify patients with a higher IHD risk and modify risk factors beforehand. Full article
(This article belongs to the Special Issue New Insights into Ischemic Heart Disease: Diagnosis, Risk Assessment, Prevention and Treatment Strategies)
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