Postoperative atrial fibrillation (POAF) after cardiac surgery: clinical practice review

Journal of Thoracic Disease, Journal Year: 2024, Volume and Issue: 16(2), P. 1503 - 1520

Published: Feb. 1, 2024

Abstract: Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited efficacy, several perioperative interventions can reduce patients' risk of POAF. These begin preoperative medications, including beta-blockers amiodarone. Moreover, patients should be screened for preexisting (AF) so that concomitant surgical ablation left appendage occlusion performed in appropriate candidates. Intraoperative such as posterior pericardiectomy mediastinal fluid accumulation, which a trigger Furthermore, many preventive strategies POAF are implemented the immediate postoperative period. Initiating beta-blockers, amiodarone, or both reasonable most patients. Overdrive pacing, colchicine, steroids been used by some, although evidence base less robust. For POAF, rate-control rhythm-control comparable outcomes. Decision-making regarding anticoagulation recognize stroke appears to lower than general nonvalvular AF. The oral reduces clear Given tends shorter-lived greater bleeding risks period, decisions individualized. Finally, wearable technology machine learning algorithms better predicting managing appear coming soon. technologies comprehensive clinical program could meaningfully incidence this common complication.

Language: Английский

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Cellular and molecular mechanisms driving cardiac tissue fibrosis: On the precipice of personalized and precision medicine

Cardiovascular Pathology, Journal Year: 2024, Volume and Issue: 71, P. 107635 - 107635

Published: March 19, 2024

Cardiac fibrosis is a significant contributor to heart failure, condition that continues affect growing number of patients worldwide. Various cardiovascular comorbidities can exacerbate cardiac fibrosis. While fibroblasts are believed be the primary cell type underlying fibrosis, recent and emerging data suggest other types also potentiate or expedite fibrotic processes. Over past few decades, clinicians have developed therapeutics blunt development progression these strategies yielded positive results, overall clinical outcomes for suffering from failure continue dire. Herein, we overview molecular cellular mechanisms tissue To do so, establish known drive in heart, outline diagnostic tools available, summarize treatment options used contemporary practice. Finally, underscore critical role immune microenvironment plays pathogenesis

Language: Английский

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Pericardial Inflammatory Mediators That Can Drive Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Canadian Journal of Cardiology, Journal Year: 2023, Volume and Issue: 39(8), P. 1090 - 1102

Published: June 8, 2023

Language: Английский

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Psychological Discomfort in Patients Undergoing Coronary Artery Bypass Graft (CABG) in West Bank: A Cohort Study

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(7), P. 2027 - 2027

Published: March 30, 2024

Background/Objetives: Cardiovascular disease (CVD) remains a significant contributor to global morbidity and mortality rates. Coronary artery bypass graft (CABG) surgery is critical intervention for patients with coronary disease, yet it poses psychological challenges that can impact recovery. Methods: This prospective cohort study, conducted across six hospitals in the West Bank/Palestine, aimed assess changes depression, anxiety, stress levels among CABG identify associated factors. The Arabic version of Depression Anxiety Stress Scales (DASS-21) was administered before (one week) after (two three weeks). Results: Of 200 participants, 116 were men (58%). High observed both surgery, statistically reductions all these variables (p < 0.001). Regarding demographic factors, age displayed weak positive correlation depression (r = 0.283; p 0.001), anxiety 0.221; 0.002), 0.251; Sex showed pre-surgery −0.160; 0.024). Conclusions: Patient outcomes could be improved by early identification provision efficient treatments such as psychosocial therapy surgery.

Language: Английский

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Pericardial Fluid Biomarkers as Early Predictors for Postoperative Atrial Fibrillation—A Systematic Review

Diagnostics, Journal Year: 2025, Volume and Issue: 15(4), P. 408 - 408

Published: Feb. 7, 2025

(1) Background: Postoperative atrial fibrillation (POAF) is one of the most common complications cardiac surgery, frequently occurring in first 2-4 days after surgery. With a variable incidence depending on type research recent years has focused identifying predisposing factors with aim correcting them and thus decreasing risk cardiovascular total morbidity mortality. The analysis pericardial fluid allowed identification biomarkers (interleukin-6, mitochondrial DNA, myeloperoxidase or natriuretic peptides) whose presence postoperatively was associated increased POAF. (2) Materials Methods: We conducted search EMBASE PubMed identified 75 articles, which 10 entered final analysis. (3) Results: Patients who develop POAF accumulate large amounts interleukin 6, myeloperoxidase, secondary peptide as consequence inflammatory status, remodeling, disturbance homeostasis various ions. There are also observations that their levels pericardium correlate blood levels, but further studies larger cohorts patients needed to provide new evidence this regard. (4) Conclusions: Early recognition at developing based easy-to-dose easy-to-use biochemical biomarkers, association been demonstrated so far small patients, both therapeutic prognostic implications, justifies patients.

Language: Английский

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Cardiac surgery elicits pericardial inflammatory responses that are distinct compared with postcardiopulmonary bypass systemic inflammation

JTCVS Open, Journal Year: 2023, Volume and Issue: 16, P. 389 - 400

Published: July 27, 2023

ObjectivesCardiac surgery using cardiopulmonary bypass contributes to a robust systemic inflammatory process. Local intrapericardial postsurgical inflammation is believed trigger important clinical implications, such as postoperative atrial fibrillation and intrathoracic adhesions. Immune mediators in the pericardial space may underlie complications.MethodsIn this prospective pilot study, 12 patients undergoing isolated coronary artery graft were enrolled. Native fluid venous blood samples (baseline) collected immediately after pericardiotomy. Postoperative 48-hours compared with baseline. Flow cytometry determined proportions of specific immune cells, whereas multiplex analysis probed for mediators.ResultsNeutrophils are predominant cells both peripheral postoperatively. There significantly more CD163lo macrophages effluent surgery. Although there CD163hi native baseline blood, fewer these present blood. Postoperatively, concentration interleukin receptor antagonist 6, 8 higher After surgery, has matrix metalloproteinase 3, 8, 9. The same trend was observed transformational growth factor β.ConclusionsCardiac elicits an response space, which differs from responses. Future work should determine whether or not distinct local complications could be modified influence outcomes.

Language: Английский

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Exploring the role of pericardial miRNAs and exosomes in modulating cardiac fibrosis

Cardiovascular Pathology, Journal Year: 2024, Volume and Issue: 73, P. 107671 - 107671

Published: June 19, 2024

The potential of the pericardial space as a therapeutic delivery tool for cardiac fibrosis and heart failure (HF) treatment has yet to be elucidated. Recently, miRNAs exosomes have been discovered present in human fluid (PF). Novel studies shown characteristic PF miRNA compositions associated with diseases higher expressions compared peripheral blood. Five key found differentially expressed HF, angina pectoris, aortic stenosis, ventricular tachycardia, congenital either atrial fibrillation or sinus rhythm. As miRNA-based therapeutics HF showed promising results several vivo multiple miRNAs, we hypothesize role delivered through cavity. This is underlined by favorable first phase 1b clinical trial this emerging field. Presenting antisense drug trial, inhibition miR-132 intravenous administration novel oligonucleotide, CDR132L, established efficacy reducing plasma samples dose-dependent manner. We screened literature, provided an overview PF, drew connection those previously elucidated HF. Further, speculate about implications methods.

Language: Английский

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Differences in metalloproteinases and their tissue inhibitors in the cerebrospinal fluid are associated with delirium

Communications Medicine, Journal Year: 2024, Volume and Issue: 4(1)

Published: June 27, 2024

Abstract Background The aetiology of delirium is not known, but pre-existing cognitive impairment a predisposing factor. Here we explore the associations between and cerebrospinal fluid (CSF) levels matrix metalloproteinases (MMPs) their tissue inhibitors (TIMPs), proteins with important roles in both acute injury chronic neurodegeneration. Methods Using 13-plex Discovery Assay®, quantified CSF 9 MMPs 4 TIMPs 280 hip fracture patients (140 delirium), 107 cognitively unimpaired individuals, 111 Alzheimer’s disease dementia. two delirium-free control groups without trauma were included to unravel effects (hip fracture), dementia, delirium. Results show that associated higher MMP-2, MMP-3, MMP-10, TIMP-1, TIMP-2; trend suggests lower TIMP-4 are also Most had dementia low only marker adjusted analyses. MMP-12, TIMP-1 clearly than several other MMP/TIMPs impacted by or status. Conclusions Several significantly patients, alterations most these could likely be explained and/or pre-fracture Low appear directly delirium, role this pathophysiology should further explored.

Language: Английский

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Pericardial Immune Cells and Their Evolving Role in Cardiovascular Pathophysiology

Canadian Journal of Cardiology, Journal Year: 2023, Volume and Issue: 39(8), P. 1078 - 1089

Published: June 1, 2023

The pericardium plays several homeostatic roles to support and maintain everyday cardiac function. Recent advances in techniques experimental models have allowed for further exploration into the cellular contents of itself. Of particular interest are various immune cell populations present space within pericardial fluid fat. In contrast cells comparable pleura, peritoneum heart, appear be distinct their function phenotype. Specifically, recent work has suggested these play critical an array pathophysiological conditions including myocardial infarction, pericarditis, post-cardiac surgery complications. this review, we spotlight currently identified mice humans, role cells, clinical significance immunocardiology axis cardiovascular health.

Language: Английский

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Acute Pericardial Post-Ischemic Inflammatory Responses: Characterization Using A Preclinical Porcine Model

Cardiovascular Pathology, Journal Year: 2024, Volume and Issue: 73, P. 107686 - 107686

Published: Aug. 19, 2024

Pericardial fluid (PF) contains cells, proteins, and inflammatory mediators, such as cytokines, chemokines, growth factors, matrix metalloproteinases. To date, we lack an adequate understanding of the response that acute injury elicits in pericardial space.

Language: Английский

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