Cardiology Plus

Bile acid and cholesterol metabolism in atherosclerotic cardiovascular disease and therapy John Y. L. Chiang, Jessica M Ferrell, Yue Wu, Shannon Boehme Cardiology Plus 2020 5(4):159-170 Dysregulation of lipid metabolism is a major factor contributing to atherosclerotic cardiovascular disease (ACVD), which is the number one cause of death in western countries. The liver plays a central role in maintaining whole body cholesterol homeostasis via catabolism of cholesterol to bile acids, as well as biliary cholesterol excretion. The liver synthesizes lipoproteins that transport dietary cholesterol and fats to muscle and adipose tissue, directs reverse cholesterol transport of excess cholesterol from extrahepatic tissues and macrophages to the liver to convert to bile acids, and thus, protects against metabolism-related nonalcoholic fatty liver disease (NAFLD) and ACVD. Liver fibrosis/nonalcoholic steatohepatitis increases the risk and prevalence of cardiovascular disease morbidity and mortality. Bile acids are signaling molecules and metabolic regulators that activate farnesoid X receptor and G protein-coupled bile acid receptor-1 to regulate lipid, glucose, and energy metabolism. The bidirectional regulation of bile acids and the gut microbiota determine the rate of bile acid synthesis, the bile acid pool size, and the composition of the circulating bile acid pool. The liver-intestine-heart axis regulates lipid metabolism, inflammation, and the pathogenesis of metabolic diseases such as ACVD, NAFLD, diabetes, and obesity. This review focuses on the roles of liver-to-intestine, liver-to-heart and intestine-to-heart axes in cholesterol, lipoprotein, and bile acid metabolism; signaling in heart health and ACVD; and drug therapies for atherosclerosis.

Warfarin or non-Vitamin K antagonist oral anticoagulants: Navigating the choice of oral anticoagulant drugs in the COVID-19 pandemic era Heng Cai, Xin Zhou, Qing Yang Cardiology Plus 2020 5(4):171-174 Emerging evidence indicates that thromboembolic complications are a key determinant of inhospital mortality of patients with COVID-19. Prophylactic anticoagulation therapy is an important component of inhospital management of patients with COVID-19. Considering that millions of patients worldwide are prescribed oral anticoagulation therapy, herein, we summarize the pros and cons of non-Vitamin K antagonist oral anticoagulants (NOACs) and warfarin, in terms of pharmacodynamics, and therapeutic efficacy and adverse effect monitoring in the context of the global pandemic of COVID-19. Despite a lack of evidence from high-quality randomized trials, an NOAC, rather than warfarin, would be a scientifically reasonable treatment option for patients with COVID-19 in the outpatient setting.

Chinese expert consensus on percutaneous coronary intervention through distal transradial artery access Chinese Expert Consensus Group for Percutaneous Coronary Intervention through the Distal Transradial Artery Access; Thumb Club Cardiology Plus 2020 5(4):175-185

The impact of hypertension on left ventricular diastolic dysfunction and arterial stiffness in the elderly: A cross-sectional study Miyesaier Abudureyimu, Jing-Min Zhou, Xue-Juan Jin, Xiao-Tong Cui, Kai Hu, Jun-Bo Ge Cardiology Plus 2020 5(4):186-193 Objectives: To study the prevalence of LVDD and arterial stiffness and the association with LVDD and/or arterial stiffness among residents with HTN, as well as determine whether aging was independently correlated with LVDD and arterial stiffness. This was a cross-sectional study, using results from the Shanghai Heart Health study, a national project in China. Methods: Using data from 2086 participants, we explored the associations of HTN and LVDD with or without arterial stiffness using brachial–ankle pulse wave velocity (baPWV). Correlations of LVDD with or without arterial stiffness were analyzed in adjusted multivariable logistic models. Results: The proportion of subjects with LVDD was 37.5%, arterial stiffness was 47.5%, and HTN was 58.4%. LVDD in participants with arterial stiffness occurred in 55.2% and HTN in 65.9%. Pairwise comparisons showed that systolic blood pressure was significantly different and more strongly associated with HTN (68%) (P < 0.01). For subjects with normal diastolic function of normal baPWV or LVDD with increased value of baPWV, logistic multivariate regression showed that aging (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.04–1.81) and HTN (OR: 1.45, 95% CI: 1.08–1.93) were independent correlates of LVDD with arterial stiffness. Conclusions: The prevalence of arterial stiffness increases in the early stages of LVDD. HTN and aging were independently related to LVDD with arterial stiffness among community-dwelling residents.

Cardiac anatomy for electrophysiology Siew Yen Ho Cardiology Plus 2020 5(4):194-202 This article presents some of the important structures relevant to electrophysiological intervention and mapping. Notable structures within the neighborhood of the heart are the respective courses of the esophagus and phrenic nerves. The right atrium contains the sinus node, terminal crest, and cavotricuspid isthmus. The landmarks of the triangle of Koch are a guide to the location of the atrioventricular node, while the central fibrous body and the membranous septum is a guide to the location of the atrioventricular conduction bundle. The arrangement of the ventricular outlets and attachments of semilunar valvar leaflets, as well as the location of aortic sinuses relative to the atria and left ventricular summit, are presented.

Left subclavian arterial thrombosis presenting as acute limb ischemia in a COVID-19 patient – An extreme rarity Meenakshi Gajbiye, Akshay Ashok Bafna, Kishore Deore, Swenil Shah, Varun Bafna Cardiology Plus 2020 5(4):203-206 The peak of the coronavirus disease 2019 (COVID-19) crisis has exposed a substantial number of patients presenting with manifestations of venous and arterial thrombosis. Here, described is an extremely rare case of subclavian arterial thrombosis in a COVID-19 patient. Moreover, the patient presented with normal D-dimer, antinuclear antibody, fibrinogen, serum ferritin levels, prothrombin time, and platelet count. To the best of our knowledge, this is the first such case reported till date.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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