Pathophysiological mechanisms underlying increased circulating cardiac troponin in noncardiac surgery: a narrative review

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 132(4), P. 653 - 666

Published: Jan. 22, 2024

Assay-specific increases in circulating cardiac troponin are observed 20–40% of patients after noncardiac surgery, depending on patient age, type and comorbidities. Increased is consistently associated with excess morbidity mortality surgery. Despite these findings, the underlying mechanisms unclear. The majority interventional trials have been designed premise that ischaemic disease drives elevated perioperative concentrations. We consider data showing surgery could be a nonspecific marker cardiomyocyte stress. Elevated concentrations reflect coordinated pathological processes underpinning organ injury not necessarily caused by ischaemia. Laboratory studies suggest matching coronary artery autoregulation myocardial perfusion–contraction coupling limit impact systemic haemodynamic changes myocardium, 2 ischaemia might likeliest explanation for elevation period triggers multiple cause to cross sarcolemma. A two-hit model involving two or more including inflammation, strain, adrenergic stress, autonomic dysfunction exacerbate initiate acute directly absence cell death. Consideration diverse pivotal design interpretation trials.

Language: Английский

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Pacemaker Channels and the Chronotropic Response in Health and Disease

Circulation Research, Journal Year: 2024, Volume and Issue: 134(10), P. 1348 - 1378

Published: May 9, 2024

Loss or dysregulation of the normally precise control heart rate via autonomic nervous system plays a critical role during development and progression cardiovascular disease-including ischemic disease, failure, arrhythmias. While clinical significance regulating changes in rate, known as chronotropic effect, is undeniable, mechanisms controlling these remain not fully understood. Heart acceleration deceleration are mediated by increasing decreasing spontaneous firing pacemaker cells sinoatrial node. During transition from rest to activity, sympathetic neurons stimulate activating β-adrenergic receptors intracellular cyclic adenosine monophosphate. The same signal transduction pathway targeted positive drugs such norepinephrine dobutamine, which used treatment cardiogenic shock severe failure. monophosphate-sensitive hyperpolarization-activated current (I

Language: Английский

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Autonomic balance determines the severity of COVID-19 courses

Bioelectronic Medicine, Journal Year: 2020, Volume and Issue: 6(1)

Published: Nov. 24, 2020

Abstract COVID-19 has left mankind desperately seeking how to manage dramatically rising infection rates associated with severe disease progressions. courses range from mild symptoms up multiple organ failure and death, triggered by excessively high serum cytokine levels (IL 1β, IL 6, TNF α, 8). The vagally driven cholinergic anti-inflammatory pathway (CAP) stops the action of nuclear factor κB (NF-κB), transcriptional pro-inflammatory cytokines. Thus, well-balanced release depends on adequate vagal signaling. Coronaviruses replicate using NF-κB as well. By degrading cytoplasmatic inhibitor subunits (IκB), coronaviruses induce unrestricted expression accelerating both, virus replication transcription. We hypothesize that CAP detriment due depressed tone critically determines severity COVID-19.

Language: Английский

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Cardiac Autonomic Neuropathy: A Progressive Consequence of Chronic Low-Grade Inflammation in Type 2 Diabetes and Related Metabolic Disorders

International Journal of Molecular Sciences, Journal Year: 2020, Volume and Issue: 21(23), P. 9005 - 9005

Published: Nov. 27, 2020

Cardiac autonomic neuropathy (CAN) is one of the earliest complications type 2 diabetes (T2D), presenting a silent cause cardiovascular morbidity and mortality. Recent research relates pathogenesis disease in T2D to an ensuing chronic, low-grade proinflammatory pro-oxidative environment, being hallmark metabolic syndrome. Metabolic inflammation emerges as adipose tissue inflammatory changes extending systemically, on advent hyperglycemia, reach central regions brain. In light glucose insulin homeostasis, dysbiosis or alteration gut microbiome (GM) emerges, further contributing processes through increased blood–brain barrier permeability. Interestingly, studies reveal that determinants oxidative stress progression exist at crossroad CAN manifestations, dictating their evolution along natural course development. Indeed, sympathetic parasympathetic deterioration was shown correlate with markers adipose, vascular, systemic inflammation. Additionally, evidence points out could promote sympatho-excitatory state differentially affecting secretion hormones neuromodulators, such norepinephrine, serotonin, γ-aminobutyric acid, acting renin–angiotensin–aldosterone axis. Emerging neuronal concomitant autophagic defects brainstem nuclei were described possible underlying mechanisms experimental models syndrome T2D. Drugs anti-inflammatory characteristics provide potential avenues for targeting pathways involved initiation progression. The aim this review delineate etiology context disorder characterized by elevated load.

Language: Английский

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Vagus Nerve Stimulation and Atrial Fibrillation: Revealing the Paradox

Neuromodulation Technology at the Neural Interface, Journal Year: 2022, Volume and Issue: 25(3), P. 356 - 365

Published: Feb. 19, 2022

The cardiac autonomic nervous system (CANS) plays an important role in the pathophysiology of atrial fibrillation (AF). Cardiovascular disease can cause imbalance within CANS, which may contribute to initiation and maintenance AF. Increased understanding neuromodulation CANS has resulted novel emerging therapies treat arrhythmias by targeting different circuits CANS. Regarding AF, vagus nerve have yielded promising outcomes. However, be both pro-arrhythmogenic anti-arrhythmogenic. Currently, these opposing effects stimulation (VNS) not been clearly described. aim this review is therefore discuss anti-arrhythmogenic VNS recent advances clinical practice provide future perspectives for AF.A comprehensive current literature on its tissue was performed. Both experimental studies are reviewed discussed separately.VNS exhibits effects. anatomical site settings during play a crucial determining effect electrophysiology. Since last decade, there accumulating evidence from randomized that low-level (LLVNS), below bradycardia threshold, effective treatment AF.LLVNS therapeutic modality AF further research will elucidate underlying mechanisms, optimal settings, apply LLVNS.

Language: Английский

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