MicroRNA dysregulation in diabetic ischemic heart failure patients

Increased morbidity and mortality associated with ischemic heart failure (HF) in type 2 diabetic patients requires a deeper understanding of the underpinning pathogenetic mechanisms. Given the implication of microRNAs (miRNAs) in HF, we investigated their regulation and potential role. miRNA expression profiles were measured in left ventricle biopsies from 10 diabetic HF (D-HF) and 19 nondiabetic HF (ND-HF) patients affected by non- end stage dilated ischemic cardiomyopathy. The HF groups were compared with each other and with 16 matched nondiabetic, non- HF control subjects. A total of 17 miRNAs were modulated in D-HF and/or ND-HF patients when compared with control subjects. miR-216a, strongly increased in both D-HF and ND-HF patients, negatively correlated with left ventricular ejection fraction. Six miRNAs were differently expressed when comparing D-HF and ND-HF patients: miR-34b, miR-34c, miR-199b, miR- 210, miR-650, and miR-223. Bioinformatic analysis of their modulated targets showed the enrichment of cardiac dysfunctions and HF categories. Moreover, the hypoxia-inducible factor pathway was activated in the noninfarcted, vital myocardium of D-HF compared with ND-HF patients, indicating a dysregulation of the hypoxia response mechanisms. Accordingly, miR-199a, miR-199b, and miR-210 were modulated by hypoxia and high glucose in cardiomyocytes and endothelial cells cultured in vitro. In conclusion, these findings show a dysregulation of miRNAs in HF, shedding light on the specific disease mechanisms differentiating diabetic patients

Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery.

Postoperative bleeding is common after cardiac surgery. Major bleeding (MB) is a determinant of red blood cell (RBC) transfusion, especially in patients with preoperative anemia. Preoperative anemia and RBC transfusions are recognized risk factors for operative mortality. The present study investigates the role of MB as an independent determinant of operative mortality in cardiac surger

Coronary artery fistulas: clinical consequences and methods of closure. A literature review

Coronary fistulas are uncommon anomalies of congenital and rarely iatrogenic etiology. Their clinical significance is mainly dependent on the severity of the left-to-right shunt they are responsible for. Symptoms, high-flow shunting and the occurrence of complications, only partially related to the magnitude of the shunt, are the main indications for their closure, especially in the adult population. Pediatric patients, even asymptomatic but presenting with electrocardiographic or chest X-ray abnormalities, should be treated in order to avoid the long-term complications related to the presence of the fistula. Treatment of adult asymptomatic patients with non-significant shunting is still a matter of debate. Surgery and direct epicardial or endocardial ligation were traditionally viewed as the main therapeutic method for the closure of coronary fistulas. Progress in the techniques of endoluminal intervention has led to fistula embolization using different devices including coils, balloons and chemicals. The success rate is good and the procedure-related morbidity acceptable

Right Ventricular Pulmonary Hypertension

In heart failure (HF) syndrome, the development of pulmonary hypertension (PH), right ventricular (RV) dysfunction and failure are ominous prognostic signs. Pathophysiology, clinical interest and targeted therapeutic approaches for left-sided PH and its consequences on RV function have been traditionally confined to advanced HF stages. Community- and population-based studies have clearly indicated that PH is frequent even in HF patients with preserved ejection fraction, and may carry important prognostic implications in normal ageing as well. HF guidelines are inconclusive on both preventive and curative strategies for left-sided PH and its consequences on RV function. The search for new therapeutic opportunities targeted on pulmonary vascular and right heart remodeling are an important challenge for the future

Surgical ventricular restoration : is there any difference in outcome between anterior and posterior remodeling?

The purpose of this study was to compare the early and long-term outcomes in a consecutive population who underwent surgical ventricular reconstruction (SVR) for either anterior or posterior remodeling. METHODS: Among 501 consecutive patients who underwent SVR at our institution between July 2001 and December 2011, 56 patients presented with posterior remodeling (group A; mean age, 65 \ub1 10 years), whereas anterior remodeling was evident in 445 patients (group B; mean age, 65 \ub1 9 years). The 2 groups were comparable regarding cardiac risk factors and comorbidities. Patients in group A presented with larger left ventricles, higher left ventricular (LV) cardiac mass, and higher ejection (EF) and stroke volume (p = 0.01) compared with patients in group B. Moderate to severe mitral regurgitation was present in 50% and 25% of patients in groups A and B, respectively (p = 0.01). RESULTS: Thirty-day mortality was not significantly different between the 2 groups (5.4% versus 8.3% in groups A and B, respectively; p = 0.32). At logistic regression analysis, only preoperative age, creatinine, and ejection fraction (ACEF) score was an independent predictor of early mortality. Sixteen patients (29%) in group A and 92 patients (21%) in group B died during follow-up (p = 0.12). Kaplan-Meier cumulative survival was comparable between the 2 groups (log-rank p = 0.27). At multivariate Cox regression analysis, preoperative age, advanced New York Heart Association (NYHA) class, preoperative severe mitral regurgitation (MR), and preoperative tricuspid annular plane systolic excursion (TAPSE) score less than 16 were independent predictors of late mortality. CONCLUSIONS: Patients presenting with posterior remodeling showed worse clinical signs of angina and congestive heart failure (CHF) and a higher proportion of moderate to severe MR; however in the present experience early and long-term outcomes after SVR seemed to be unaffected by remodeling location