Salvianolate is the main water-soluble bioactive compound of Salvia Miltiorrhiza Bunge and is now clinically used in the treatment of cardiovascular diseases in China. However, its applications in the prevention of atrial interstitial fibrosis (AIF) and atrial fibrillation (AF) are not fully revealed. To investigate the preventive effect of salvianolate on the pathogenesis of AF in post-myocardial infarction (MI) rats and to elucidate the potential mechanisms. Rats underwent left anterior descending coronary artery ligation were randomized into four groups and administered intraperitoneally with vehicle (MI group, n = 13), or 10, 20 and 40 mg/kg salvianolate (Sal-L, Sal-M and Sal-H group, n = 13, 14 and 13 respectively) for totally five weeks. Rats underwent sham operation was used as control group (Sham, n = 10). Then, echocardiography and AF inducibility test were detected. Tissues and serum were collected for Sirius red and fast green counter stain or hematoxylin-eosin to assess atrial interstitial fibrosis and hypertrophy, or for western blot and ELISA analysis. Salvianolate injection significantly improved cardiac function, reduced left atrial enlargement and P-wave duration, and decreased not only the vulnerability to AF but also AF duration. Histologic analysis showed that salvianolate mitigated AIF and atrial hypertrophy. Western blot analysis found that salvianolate inhibited the TGFβ1/Smad2/3 mediated-collagen deposition and inhibited the TXNIP/NLRP3 inflammasome /IL-1β and IL-18 signal pathway. ELISA analysis showed that salvianolate significantly reduced the serum concentrations of BNP, IL-6, CRP and TGFβ1. Salvianolate may constitute a novel upstream therapy for AF by suppressing AIF. The underlying mechanism may be attributable to its inhibitory effects on TGF-β1/Smad2/3 and TXNIP/NLRP3 inflammasome signaling pathway.

To depict the interaction between atrial fibrillation (AF) and inflammatory reaction, studies were taken to measure the activity of NF-kappaB in myocardium, the concentration of regional inflammatory factors and the pathological process of the right atrium in patients with AF. Patients with valvular disease with AF or sinus rhythm (SR) were recruited and compared. Before the extracorporal circulation, about 250 mg tissue of right atrium was collected for pathological examination. The activity of NF-kappaB in myocardium was measured by electrophoretic mobility shift assay (EMSA), and the concentration of cardiac tissue interleukin-6 (IL-6) and tumor necrosis factor (TNF-alpha) was determined by radioimmuoassay. Patients with valvular disease with AF exhibited higher NF-kappaB activity, higher concentration of TNF-alpha and IL-6, severe lymphomonocyte infiltration, and more fibrosis than those patients with valvular disease with SR. There were significant positive correlations among NF-kappaB activity and levels of TNF-alpha and IL-6 and collagen volume fraction. This study proved the presence of inflammation in atrial myocardium by triggering inflammatory reaction.

Background: Acute coronary syndromes (ACS) are the leading cause of global death. Optimizing mortality risk prediction and early identification of high-risk patients is essential for developing targeted prevention strategies. Many researchers have built machine learning (ML) models to predict the mortality risk in ACS patients. Our meta-analysis aimed to evaluate the predictive value of various ML models in predicting death in ACS patients at different times.Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched systematically from database establishment to March 12, 2022 for studies developing or validating at least one ML predictive model for death in ACS patients. We used PROBAST to assess the risk of bias in the reported predictive models and a random-effects model to assess the pooled C-index and accuracy of these models.Results: Fifty papers were included, involving 216 ML prediction models, 119 of which were externally validated. The combined C-index of the ML models in the validation cohort predicting the in-hospital mortality, 30-day mortality, 3- or 6-month mortality, and 1 year or above mortality in ACS patients were 0.8633 (95% CI 0.8467–0.8802), 0.8296 (95% CI 0.8134–0.8462), 0.8205 (95% CI 0.7881–0.8541), and 0.8197 (95% CI 0.8042–0.8354), respectively, with the corresponding combined accuracy of 0.8569 (95% CI 0.8411–0.8715), 0.8282 (95% CI 0.7922–0.8591), 0.7303 (95% CI 0.7184–0.7418), and 0.7837 (95% CI 0.7455–0.8175), indicating that the ML models were relatively excellent in predicting ACS mortality at different times. Furthermore, common predictors of death in ML models included age, sex, systolic blood pressure, serum creatinine, Killip class, heart rate, diastolic blood pressure, blood glucose, and hemoglobin.Conclusions: The ML models had excellent predictive power for mortality in ACS, and the methodologies may need to be addressed before they can be used in clinical practice.

Background: Dyslipidemia is a critical driver in the development of coronary heart disease (CHD), which further exacerbates the risk of major adverse cardiovascular events (MACEs). Chinese herbal medicine (CHM) plays an important role in the regulation of lipid levels and improvement of prognosis. However, few systematic reviews report whether the efficacy of CHM therapy for regulating lipid levels and lowering cardiovascular events is associated with baseline lipid levels.Methods: Randomized controlled trials assessing efficacy of CHM for lipid profiles and MACEs among patients with CHD were searched in six databases. Two authors independently extracted studies according to a predesigned form. Cochrane risk of bias tool and Grading of Recommendations Assessment, Development, and Evaluation system were used to assess the methodological quality of the included studies. The primary outcomes were blood lipid levels and MACEs including cardiovascular mortality, non-fatal myocardial infarction, revascularization, angina pectoris, heart failure, and non-fatal stroke across baseline lipid levels. The secondary outcomes were individual components of the primary outcomes.Results: A total of 23 trials with 7,316 participants were included in this study. Altogether 377 cardiovascular events occurred in 3,670 patients in the CHM group, while 717 events occurred in 3,646 patients in the Western medicine–alone group. Compared with the Western medicine alone, additional CHM significantly lowered low-density lipoprotein cholesterol (LDL-C) [MD = −0.46, 95% CI (−0.60 to −0.32), P < 0.00001, I² = 96%]. The risk reduction in MACEs associated with CHM vs. Western medicine therapy was 0.52 [95% CI (0.47–0.58), P < 0.00001, I² = 0%], but varied by baseline LDL-C level (P = 0.03 for interaction). Triglycerides (TG) level was also significantly lowered by additional CHM vs. Western medicine alone [MD = −0.27, 95% CI (−0.34 to −0.20), P < 0.00001, I² = 81%], and risk reduction for MACEs also varied with baseline TG, with greater risk reduction in higher baseline TG subgroups (P = 0.03 for interaction). Similar results were observed with total cholesterol and high-density lipoprotein cholesterol.Conclusion: Compared with Western medicine alone, additional CHM was associated with lower risk of cardiovascular events and improvement of lipid profiles. Risk reduction for cardiovascular events was associated with baseline LDL-C and TG levels.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023425791.