Novel Diagnostic and Therapeutic Strategies in Cardiovascular Medicine

Background and Objectives: Sevoflurane, a widely used volatile anesthetic, can induce oxidative stress and apoptosis, but the underlying mechanisms in human cardiomyocytes remain unclear. This study investigated the role of transient receptor potential vanilloid 1 (TRPV1) channels in sevoflurane-induced cardiotoxicity and the potential mitigating effect of ascorbic acid. Materials and Methods: Human cardiomyocytes were exposed to sevoflurane (5.1%, 6 h) and/or ascorbic acid (1 mM, 30 min), with or without the TRPV1 channel antagonist capsazepine and with the TRPV1 channel agonist Capsaicin. Intracellular calcium, reactive oxygen species (ROS), apoptosis, mitochondrial membrane potential, and caspase-3/9 activities were assessed. Results: Sevoflurane significantly increased intracellular calcium levels, ROS production, mitochondrial depolarization, apoptosis, and caspase-3/9 activity compared with controls (p < 0.001). These effects were attenuated by capsazepine, suggesting a role for TRPV1 involvement. Ascorbic acid pretreatment significantly reduced sevoflurane-induced elevations in all parameters (p < 0.001). Combined ascorbic acid and capsazepine treatment yielded further reductions in calcium, ROS, apoptosis, and caspase activities compared to ascorbic acid alone (p < 0.05). Conclusions: Sevoflurane induces apoptosis in human cardiomyocytes via ROS-mediated activation of the TRPV1 channel, leading to calcium overload, mitochondrial dysfunction, and caspase-dependent cell death. Ascorbic acid exerts mitigating effects by reducing oxidative stress and modulating TRPV1 channel activity, suggesting a potential therapeutic strategy for myocardial protection during sevoflurane anesthesia. Full article

Background and Objectives: Atherosclerosis continues to be a major determinant of the global health burden, with ischemic heart disease representing one of the leading causes of morbidity and mortality worldwide. Although cardiovascular (CV) prevention strategies focus on pro-atherogenic lipoproteins, such as LDL-C, non-HDL-C, and apoB, the balance between atherogenic and anti-atherogenic lipoproteins may better reflect the overall atherogenic burden. Apolipoprotein B (apoB) reflects the total number of circulating atherogenic particles, whereas apolipoprotein A-I (apoA) is the main protein component of HDL, the major anti-atherogenic lipoprotein. Integrating these two parameters into the apoB/apoA ratio results in a composite biomarker that reflects this balance. In this study, we aimed to evaluate whether the apoB/apoA ratio can predict the presence and the severity of coronary artery disease (CAD) in a cohort from an Eastern European hospital, under moderate-intensity statin treatment. Additionally, we assessed whether lipoprotein(a) [Lp(a)] provides any additional diagnostic value. Materials and Methods: We consecutively enrolled 121 statin-treated patients, who presented for elective invasive coronary angiography. Patients with history of coronary revascularization or acute coronary syndrome were excluded. The study cohort was further divided into two groups, according to the severity of coronary stenosis: 69 patients with non-significant CAD (N-CAD) and 52 patients with hemodynamically significant CAD (S-CAD). Apolipoprotein B, apolipoprotein A-I, and lipoprotein(a) were measured using a standardized immunoturbidimetric assay, at the moment of enrollment. The severity of coronary stenosis was measured using Quantitative Coronary Analysis (QCA) software and the total coronary atherosclerotic burden of each patient was quantified using the Gensini score. Results: The apoB/apoA ratio was significantly higher in the S-CAD groups, compared with N-CAD patients (0.53 ± 0.16 vs. 0.73 ± 0.18). Furthermore, in the apoB/apoA-based analysis, the Gensini score increased progressively across the three tertiles (8.55 ± 19.60 vs. 14.57 ± 21.65 vs. 29.8 ± 27.78, p = 0.000) and so did the percentage of patients with three-vessel disease (5% vs. 19.5% vs. 32.5%, p = 0.000) and left main disease (5% vs. 7.3% vs. 20%, p = 0.031). The apoB/apoA ratio showed a significant correlation with the severity of CAD, as expressed by the Gensini score (r = 0.513, p < 0.001, 95% CI: 0.357–0.641). The association between apoB/apoA ratio and the presence and severity of CAD expanded beyond group comparison. In the logistic regression, this biomarker proved to be a valuable predictor for S-CAD (per SD increase: OR 2.509, 95% CI: 1.441–4.369, p = 0.001), three-vessel disease (per SD increase: OR 2.339, 95% CI: 1.427–3.892, p = 0.001), and left main disease (per SD increase: OR 2.771, 95% CI: 1.489–5.156, p = 0.001). The apoB/apoA ratio remained significant after adjusting for other CV risk factors and independent to LDL-C, as shown by the analysis that we performed among the lowest LDL-C tertile patients. Participants with S-CAD showed higher concentrations of Lp(a). However, adding this lipoprotein to the multivariate analysis, resulted only in a marginal improvement in the predictive power. Conclusions: The ApoB/apoA ratio emerged as an independent predictor for hemodynamically significant coronary stenosis and for CAD severity. Additionally, higher apoB/apoA values were associated with anatomical high-risk features, such as three-vessel disease or left main disease. In contrast, Lp(a) did not provide a substantial increase in the predictive power of multivariate models in this stable CAD cohort. Full article