Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Toda, H.; Nakamura, Kazufumi; Nakagawa, Koji; Watanabe, Atsuyuki; Miyoshi, Toru; Nishii, Nobuhiro; Shimizu, Kazuyoshi; Hayashi, Masao; Morita, Hiroshi; Morimatsu, Hiroshi; Ito, Hiroshi

doi:10.1253/circj.cj-17-0747

Cited by 23 publications

(19 citation statements)

References 41 publications

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“…We have previously reported that intraoperative tachycardia is an independent predictive factor for cardiovascular events. 21 In the present study, however, baseline heart rate at rest was not associated with the incidence of PMI or with cardiovascular events. Distribution of PMI by type of surgical procedure is an important consideration, but the incidence of PMI did not differ significantly by surgical procedure in this trial.…”

Section: Efficacycontrasting

confidence: 74%

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery　― Multicenter Randomized Controlled Study ―

Toda

Nakamura

Shimizu

et al. 2020

Circ J

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on behalf of the MAMACARI Investigators Background: The aim of this study was to evaluate the efficacy and safety of transdermal β-blocker patches, which offer stable blood concentration and easy availability during operation, for prevention of perioperative myocardial injury (PMI) in high-risk patients. Methods and Results: In this randomized controlled trial, patients aged >60 years with hypertension and high revised cardiac risk index (≥2) undergoing non-cardiac surgery were randomly assigned to a bisoprolol patch or control group. Primary efficacy outcome was incidence of PMI, defined as postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL and relative hs-cTnT change ≥20%. Secondary efficacy outcomes were number of cardiovascular events and 30-day mortality. From November 2014 to February 2019, 240 patients from 5 hospitals were enrolled in this study. The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in the control group (P=0.18). Incidence of major adverse cardiac events including non-critical myocardial infarction, strokes, decompensated heart failure and tachyarrhythmia was similar between the 2 groups. Tachyarrhythmia tended to be higher in the control group. There were no significant differences in safety outcomes including significant hypotension and bradycardia requiring any treatment between the 2 groups. Conclusions: Bisoprolol patches do not influence the incidence of PMI and cardiovascular events in high-risk patients undergoing non-cardiac surgery, but perioperative use of these patches is safe.

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Section: Efficacycontrasting

confidence: 74%

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery　― Multicenter Randomized Controlled Study ―

Toda

Nakamura

Shimizu

et al. 2020

Circ J

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“…Overexpression of miR-15a-5p was found in hypertrophic cardiomyopathy (HCM) patients with diffuse myocardial fibrosis which increased ventricular stiffness, contributing to diastolic heart failure [15]. Heart failure, in turn, posed a higher risk for embolic stroke [16, 17]. As evidenced by published paper, elevated expression of serum miR-17-5p was associated with acute ischemic stroke [18].…”

Section: Discussionmentioning

confidence: 99%

MicroRNA Expression Profiles Identify Biomarker for Differentiating the Embolic Stroke from Thrombotic Stroke

Chen

Jiang

2018

BioMed Research International

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In order to identify potential biomarkers that distinguish the embolic stroke (ES) from thrombotic stroke (TS), a profile of microRNA expression was analyzed. The GSE60319 expression profile was downloaded from the Gene Expression Omnibus (GEO) database. The GEO2R was applied to screen for differentially expressed microRNAs (DEmiRNAs) between the embolic stroke group and thrombotic stroke group. The miRWalk was utilized to predict the target genes of DEmiRNAs. Genes associated with embolic stroke were downloaded from the Comparative Toxicogenomics Database. Cross reference of target genes to disease related genes was conducted to construct the DEmiRNA-gene network. The protein-protein interaction (PPI) network of overlapping genes was evaluated by STRING, using the MCODE and CytoHubba plugin of Cytoscape to identify the modules and hub genes. The enrichment of Kyoto Encyclopedia of Genes and Genomes (KEGG) in modules was performed. There were 30 microRNAs in total identified as DEmiRNAs between embolic stroke and thrombotic stroke groups, of which 8 were upregulated and 22 were downregulated. Among these differentially expressed miRNAs, miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were significantly associated with an ES to TS. Using the miRWalk 3.0 online tool, target genes regulated by DEmiRNAs were predicted. In addition, disease related genes were predicted and compared with target genes of DEmiRNAs. 166 overlapped genes regulated by miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were identified, suggesting their association with diseases that contributed to ES, mainly including atrial fibrillation, mitral valve stenosis, myocardial infarction, and aortic dissection. Therefore, miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were promising candidate biomarkers for differentiating an ES from TS. The PPI network demonstrated that miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were associated with an ES by mainly regulating “CCND1, E2F2, E2F3, ITCH, UBE4A, UBE3C, RBL2, FBXO31, EIF2C4, and EIF2C1”. Furthermore, miR-15a-5p and miR-17-5p may function through “cell cycle, prostate cancer, and small cell lung cancer” while miR-19b-3p and miR-20a-5p function through “insulin resistance, hepatitis B, and viral carcinogenesis” and “vasopressin-regulated water reabsorption”, respectively. However, these results were approached in the manner of bioinformatics analysis; therefore, further verification is required.

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“…39 Fluid overload is extremely common postoperatively, and preoperative left ventricular diastolic dysfunction has been strongly associated with postoperative myocardial injury. 40 Recent investigations using blood samples from the VISION 32 and METS 25 cohorts suggest myocardial injury has an inflammatory etiology. 41,42 Based on these facts, it is unlikely that all patients classified as having MINS had myocardial ischemia, and in my opinion, as an endpoint or a diagnosis, MINS is fundamentally flawed.…”

Section: Asymptomatic Pulmonary Embolism Is Common and Ismentioning

confidence: 99%

The emergence of a postoperative myocardial injury epidemic: true or false?

Beattie

2021

Can J Anesth/J Can Anesth

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Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Cited by 23 publications

References 41 publications

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery　― Multicenter Randomized Controlled Study ―

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery　― Multicenter Randomized Controlled Study ―

MicroRNA Expression Profiles Identify Biomarker for Differentiating the Embolic Stroke from Thrombotic Stroke

The emergence of a postoperative myocardial injury epidemic: true or false?

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Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Cited by 23 publications

References 41 publications

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery ― Multicenter Randomized Controlled Study ―

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery ― Multicenter Randomized Controlled Study ―

MicroRNA Expression Profiles Identify Biomarker for Differentiating the Embolic Stroke from Thrombotic Stroke

The emergence of a postoperative myocardial injury epidemic: true or false?

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Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery　― Multicenter Randomized Controlled Study ―

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery　― Multicenter Randomized Controlled Study ―