*For medical professionals only
“img class=”content ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >Economic needs and the provision of basic services to the general population require continuous human resource support, resulting in 20%-30% of the workforce being required to undertake shift (night shift) work. Biorhythm disturbances caused by shift work are associated with an increased risk of chronic diseases, including cardiovascular disease, cancer, and metabolic dysfunction. Interventions targeting circadian rhythm disturbances may be a new way to reduce the risk of cardiovascular disease and other diseases, according to two ongoing studies exploring the mechanisms by which shift work impairs health.
Acute myocardial infarction (AMI) remains the leading cause of morbidity and mortality worldwide. However, reperfusion therapy triggers cell death and an inflammatory response (known as reperfusion injury) that leads to eventual infarct size and heart failure in survivors. Although reperfusion injury following coronary recanalization is a major determinant of clinical outcomes in AMI, the effect of shift work on reperfusion injury in myocardial infarction (MI) has never been investigated.
Recently, JACC magazine published a study by Professor Bu Jun’s team from the Department of Cardiology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, in a cardiac magnetic resonance (CMR) scan. Let’s take a look at the impact of shift work on reperfusion injury and clinical outcomes in a prospective multicenter cohort of patients with STEMI.
Methods
Study patient data from EARLY- The MYO-CMR registry, a prospective multicenter registry cohort of patients with ST-segment elevation myocardial infarction (STEMI) who completed cardiac magnetic resonance (CMR) imaging after reperfusion therapy.
The primary endpoint was CMR-diagnosed post-reperfusion infarct size.
The secondary clinical endpoint was a composite of major adverse cardiac events (MACE) during follow-up.
The underlying mechanism was explored using a preclinical animalAMI model.
results
Among the 706 patients enrolled in the earlyMYO-CMR registration, 412 patients with STEMI were finally included.
Shift work was associated with increased infarct size as defined by CMR
(β=5.94%; 95% confidence interval: 2.94-8.94; P<0.0001).
Shift work was associated with increased risk of MACE during a median follow-up of 5.0 years
(adjusted HR: 1.92 ; 95% confidence interval: 1.12-3.29; P=0.017).
Consistent with clinical results, simulated “shift work” in mice and sheep significantly enhanced reperfusion injury in AMI .
Mechanistic studies reveal a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine 1 axis in the heart that mediates shift work It plays a crucial role in the detrimental effects of myocardial damage.
Study Conclusions
Current research provides new findings that shift work increases Myocardial infarction reperfusion injury.
A novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine 1 axis was discovered in the heart, which may play a role in mediating this process. play a key role in.
Review Highlights
< span>Disruption of circadian rhythms by shift work exacerbates myocardial infarction injury in preclinical models and in patients with STEMI. This may be mediated by the NR1D1/CLCF1 axis in the heart.
Further studies are needed to determine whether changes in the frequency or duration of shift work improve cardiovascular outcomes in patients with AMI.
Source:
< span>Disruption of Circadian Rhythms by Shift Work Exacerbates Reperfusion Injury in Myocardial Infarction. J Am Coll Cardiol 2022;79:2097–2115. doi:10.1016/j.jacc.2022.03.370
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