Hyperglycemic memory in diabetic cardiomyopathy

Cardiovascular diseases account for approximately 80% of deaths among individuals with diabetes mellitus, with diabetic cardiomyopathy as the major diabetic cardiovascular complication. Hyperglycemia is a symptom that abnormally activates multiple downstream pathways and contributes to cardiac hypertrophy, fibrosis, apoptosis, and other pathophysiological changes. Although glycemic control has long been at the center of diabetes therapy, multicenter randomized clinical studies have revealed that intensive glycemic control fails to reduce heart failure-associated hospitalization and mortality in patients with diabetes. This finding indicates that hyperglycemic stress persists in the cardiovascular system of patients with diabetes even if blood glucose level is tightly controlled to the normal level. This process is now referred to as hyperglycemic memory (HGM) phenomenon. We briefly reviewed herein the current advances that have been achieved in research on the underlying mechanisms of HGM in diabetic cardiomyopathy.

PULMONARY HYPERTENSION IN INFANTS WITH BRONCHOPULMONARY DYSPLASIA: CAUSES, DIAGNOSIS, TREATMENT

Bronchopulmonary dysplasia (BPD) is a leading chronic pathology of premature infants, which changes the structure of the lungs and disrupts the development of pulmonary vessels. The most important cardiovascular complication of BPD is the development of pulmonary hypertension, which is diagnosed in about 25 % of severely ill infants. Pulmonary hypertension associated with BPD develops due to lung vascular abnormalities and remodeling of the pulmonary vasculature, both of which lead to an increase in vascular resistance and the development of right ventricular heart failure. The occurrence of this complication worsens the prognosis of survival in infants with BPD, prolongs the total duration of hospital stay, adversely affects long-term somatic and neurological development and increases the frequency of re-hospitalizations. All this justifies the need for timely diagnosis and treatment of pulmonary hypertension in children with BPD. This review presents new data, for the definition, diagnosis, and treatment of pulmonary hypertension associated with BPD.

Long-term outcomes following Rheumatic Heart Disease diagnosis in Australia

Aims Rheumatic Heart Disease (RHD) is a major contributor to cardiac morbidity and mortality globally. We aimed to estimate the probability and predictors of progressing to non-fatal cardiovascular complications and death in young Australians after first RHD diagnosis. Methods and Results This retrospective cohort study used linked RHD register, hospital and death data from five Australian states and territories (covering 70% of the whole population and 86% of the Indigenous population). Progression from uncomplicated RHD to all-cause death and non-fatal cardiovascular complications (surgical intervention, heart failure, atrial fibrillation, infective endocarditis, stroke) was estimated for people aged <35years with first-ever RHD diagnosis between 2010 and 2018, identified from register and hospital data. The study cohort comprised 1718 initially uncomplicated RHD cases (84.6% Indigenous; 10.9% migrant; 63.2% women; 40.3% aged 5-14-years; 76.4% non-metropolitan). The composite outcome of death/cardiovascular complication was experienced by 23.3% (95% CI: 19.5-26.9) within 8 years. Older age and metropolitan residence were independent positive predictors of the composite outcome; history of acute rheumatic fever (ARF) was a negative predictor. Population group (Indigenous/migrant/other Australian) and sex were not predictive of outcome after multivariable-adjustment. Conclusion This study provides the most definitive and contemporary estimates of progression to major cardiovascular complication or death in young Australians with RHD. Despite access to the publically-funded universal Australian healthcare system, one-fifth of initially uncomplicated RHD cases will experience one of the major complications of RHD within 8 years supporting the need for programs to eradicate RHD.

Arterial Hypertension and Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Systematic Review and Meta-Analysis

Background: Off-target effects in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) are associated with cardiovascular toxicity. Hypertension represents an important cardiovascular complication and, if not appropriately managed, can contribute to developing thrombotic events. Third-generation TKI ponatinib is associated with hypertension development, and its use is more restricted than in the past. Few data are reported for second-generation TKI, nilotinib, dasatinib, and bosutinib. The aim of this article was to evaluate with a systematic review and meta-analysis the real incidence of hypertension in CML patients treated with second- or third-generation TKI.Methods: The PubMed database, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for studies published between January 1, 2000, and January 30, 2021; the following terms were entered in the database queries: Cardiovascular, Chronic Myeloid Leukemia, CML, Tyrosine kinases inhibitor, TKI, and Hypertension. The study was carried out according to the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement.Results: A pooled analysis of hypertension incidence was 10% for all new-generation TKI, with an even higher prevalence with ponatinib (17%). The comparison with the first-generation imatinib confirmed that nilotinib was associated with a significantly increased risk of hypertension (RR 2; 95% CI; 1.39-2.88, I2=0%, z=3.73, p=0.0002). The greatest risk was found with ponatinib (RR 9.21; 95% CI; 2.86-29.66, z=3.72, p=0.0002).Conclusion: Hypertension is a common cardiovascular complication in CML patients treated with second- or third-generation TKI.

Cardiovascular Complication following Covishield Vaccination in Nepal: A Case Report

Nepal started the COVID-19 vaccination on 27 January 2021 with AstraZeneca/Oxford Coronavirus Disease-19 AZD1222 (Covishield) vaccine to control the Coronavirus disease pandemic. The vaccine has a good safety profile, with cardiovascular complications being rare. Herein we report a rare case of cardiovascular complication following Covishield vaccination in a 33 years old female who had dizziness and elevated blood pressure immediately following vaccination and abnormal electrocardiogram showing T wave inversions followed by left bundle branch block. The patient was kept on observation, following which the blood pressure and electrocardiogram changes were normal by seven days. This cardiovascular complication following the vaccination demands further investigation into the adverse event of the vaccine. However, since the benefit of the vaccine outweighs the risk, World Health Organization has recommended the continuity of the vaccine as of now.

Post COVID Cardiovascular Care - A Review

Over the last one-year COVID 19 has affected millions of people around the world. Though initially it was thought to be an infection of respiratory system, but it involves any organ of the body. Its morbidity and mortality are more when it involves patients with preexisting cardiovascular diseases and also when it causes a cardiovascular complication. COVID 19 can produce a number of cardiovascular complications including myocardial infarction, heart failure, myocarditis, arrhythmia, thromboembolism etc. Following recovery from COVID 19 infection evaluation, follow up and management of these cardiovascular conditions, which may be sometimes in subclinical form, is essential. Though there is lack of adequate studies or guidelines, we tried to discuss the different aspects of Post- COVID cardiovascular care depending on the existing evidence and previous guidelines. Cardiovasc. j. 2021; 13(2): 189-199

COVID-19 and cardiovascular disease: a review of current knowledge

The uncontrolled spread of the COVID-19 pandemic which originated in China created a global turmoil. While the world is still busy figuring out a cure for the deadly disease, scientists worked out on many theories and conducted several studies to establish a relationship between the infection and other known diseases. Cardiovascular diseases (CVD) are one of the major complications of this infection after the respiratory manifestations. Individuals with cardiovascular complication are said to be more susceptible to acquiring the infection because the novel coronavirus uses the ACE2 receptor for its entry inside the cell and there is a high level of ACE2 expression in individuals with cardiovascular complications because of the enzyme’s anti-hypertrophic, anti-fibrotic and anti-hypertensive effects on the heart. Individuals who belong to the older age group are also more susceptible. Knowing the above information, it might seem that using ACE2 inhibitors would help to slow or prevent the entry of the novel coronavirus but it would also at the same time prove to have deleterious effects on the cardiovascular system as the protective functions of ACE2 would be lost. While the search for a cure still continues it has been stated many a times that the conditions might worsen with time and the only way to keep ourselves and our family safe would be to follow the appropriate social distancing methods and get a COVID test if we experience any of the major symptoms.