Background Previous studies have extensively investigated traditional predictors of cardiovascular disease(CVD)development,progression,and prognosis.However,the influence of novel indicators such as Klotho,on CVD prev...Background Previous studies have extensively investigated traditional predictors of cardiovascular disease(CVD)development,progression,and prognosis.However,the influence of novel indicators such as Klotho,on CVD prevalence and prognosis in the general population remains unclear.Method This was an observational study that utilized cross-sectional and longitudinal methods to examine the general population in the National Health and Nutrition Examination Survey(NHANES)2007-2016.The participants were divided into four groups according to the Klotho quartiles.Primary outcome was CVD[coronary artery disease(CAD),congestive heart failure,and stroke],secondary outcomes were all-cause mortality and cardiovascular mortality.Survey-weighted binary logistic regression analysis was used to analyze the association between Klotho and the prevalence of primary outcome,and the restricted cubic spline(RCS)curve was used to further analyze the nonlinear relationship.Subgroup analyses were conducted to investigate the association between Klotho values and CVD prevalence using survey-weighted binary logistic regression.The incidence of the secondary outcomes among four groups was assessed through Kaplan-Meier survival analysis.Additionally,the relationship between Klotho values and secondary endpoints was explored using survey-weighted Cox proportional hazards regression across various patient subpopulations.Results A total of 12,146 participants(56.8±10.7 years,48.5%male)were included in our study.The total incidence of CVD was 9.9%(n=1201),of which 4.7%(n=574)were CAD,3.7%(n=454)were congestive heart failure,and 4.1%(n=497)were stroke.Binary logistics regression analysis showed that higher Klotho quartiles were associated with the decreased prevalence of CVD[Quartile 4 vs.Quartile 1:odds ratio(OR)(95%CI):0.77(0.64-0.93),P=0.006]and congestive heart failure[Quartile 4 vs.Quartile 1:0.75(0.56-0.99),P=0.048],However,no significant associations were found between Klotho levels and the outcomes of CAD or stroke.RCS curve illustrated a high Klotho value was negatively correlated with the prevalence of CVD(nonlinear P=0.838),congestive heart failure(nonlinear P=0.110)and stroke(nonlinear P=0.972).No significant interactions were observed in any subgroups regarding the associations between Klotho and prevalence of CVD.After a median follow-up period of 93 months(range:from 1 to 160 months),there were 1228 cases(10.1%)of all-cause mortality in the general population,including 296 cases(2.4%)of cardiovascular mortality.The Kaplan-Meier curves indicated that lower Klotho levels were associated with a significant increase in all-cause mortality across the general population,CVD population,and non-CVD population.As Klotho levels decreased,there was also a notable rise in cardiovascular mortality in both the general population and the CVD population.In the overall population,Cox regression analyses demonstrated that higher Klotho values were associated with a decreased risk of both all-cause and cardiovascular mortality.And no significant interaction was observed in the CVD subgroup regarding the association between Klotho and mortality.Conclusion High Klotho level was associated with low prevalence of CVD and low risk of mortality in general population.展开更多
BACKGROUND Oxidative stress is closely associated with hypertensive outcomes.The oxidative balance score(OBS)measures oxidative stress exposure from dietary and lifestyle elements.The objective of this study was to in...BACKGROUND Oxidative stress is closely associated with hypertensive outcomes.The oxidative balance score(OBS)measures oxidative stress exposure from dietary and lifestyle elements.The objective of this study was to investigate the association between OBS and mortality in hypertensive patients.METHODS This study included 7823 hypertensive patients from the National Health and Nutrition Examination Survey(NHA-NES)1999-2014.Several models,including Cox regression,restricted cubic splines(RCS),Kaplan-Meier survival analysis,subgroup,and sensitivity analyses,were exploited to investigate the relationship between OBS and the risk of mortality.RESULTS Controlling for all potential confounders,a significantly inverse association was observed between elevated OBS and all-cause[hazard ratio(HR)=0.90,95%CI:0.85-0.95]and cardiovascular mortality(HR=0.85,95%CI:0.75-0.95).With adjustment for covariates,significant associations between lifestyle OBS and mortality risks diminished,whereas associations between dietary OBS and these mortality risks remained robust(all-cause mortality:HR=0.91,95%CI:0.86-0.96;cardiovascular mortality:HR=0.85,95%CI:0.76-0.96).RCS demonstrated a linear relationship between OBS and all-cause and cardiovascular mortality risk(P_(nonlinear)=0.088 and P_(nonlinear)=0.447,respectively).Kaplan-Meier curves demonstrated that the mortality rate was lower with a high OBS(P<0.001).The consistency of the association was demonstrated in subgroup and sensitivity analyses.RCS after stratification showed that among current drinkers,those with higher OBS had a lower risk of mortality compared with former or never drinkers.CONCLUSIONS In hypertensive individuals,there was a negative association between OBS and all-cause and cardiovascular mortality.Encouraging hypertensive individuals,especially those currently drinking,to maintain high levels of OBS may be beneficial in improving their prognosis.展开更多
Cardiac arrest(CA)is one of the most common causes of death.[1-3]Despite extensive studies on the management of CA,the global survival rate in adults is only approximately 7%,and 30-day survival is even less than 2%in...Cardiac arrest(CA)is one of the most common causes of death.[1-3]Despite extensive studies on the management of CA,the global survival rate in adults is only approximately 7%,and 30-day survival is even less than 2%in China.[4]Some studies have shown that CA patients of cardiac and non-cardiac origin may differ in underlying diseases,clinical manifestations,and prognosis,which leads to diff erences in terms of the pathophysiological mechanism and treatment measure.[5,6]However,little is known about the risk factors in relation to the prognosis of CA across arrest etiologies.展开更多
BACKGROUND Triglyceride-glucose(TyG)index values are a new surrogate marker for insulin resistance.This study aimed to explore the relationship between cumulative TyG index values and atrial fibrillation(AF)recurrence...BACKGROUND Triglyceride-glucose(TyG)index values are a new surrogate marker for insulin resistance.This study aimed to explore the relationship between cumulative TyG index values and atrial fibrillation(AF)recurrence after radiofrequency catheter ablation(RFCA).METHODS A total of 576 patients with AF who underwent RFCA at the Second Affiliated Hospital of Xi'an Jiaotong University were included in this study.The participants were grouped based on cumulative TyG index values tertiles within 3 months after ablation.Cox regression and restricted cubic spline analyses were used to determine the relationship between cumulative TyG index values and AF recurrence.The predictive value of all risk factors was assessed by receiver operating curve analysis.RESULTS There were 375 patients completed the study(age:63.23±10.73 years,64.27%male).The risk of AF recurrence increased with increasing cumulative TyG index values tertiles.After adjusting for potential confounders,patients in the medium cumulative TyG index group[hazard ratio(HR)=4.949,95%CI:1.778–13.778,P=0.002]and the high cumulative TyG index group(HR=8.716,95%CI:3.371–22.536,P<0.001)had a higher risk of AF recurrence than those in the low cumulative TyG index group.The restricted cubic spline regression model also showed an increased risk of AF recurrence with increasing cumulative TyG index values.When considering cumulative TyG index values,left atrial diameter,and lactate dehydrogenase levels as a comprehensive factor,the model could effectively predict AF recurrence after RFCA[area under the curve(AUC)=0.847,95%CI:0.797–0.897,P<0.001].CONCLUSIONS Cumulative TyG index values were a risk factor for AF recurrence after RFCA.Monitoring longitudinal TyG index values may assist with optimized for risk stratification and outcome prediction for AF recurrence.展开更多
BACKGROUND The neutrophil to lymphocyte ratio(NLR)has been reported as a novel predictor for atherosclerosis and car-diovascular outcomes.This study aimed to determine the effects of NLR on long-term clinical outcomes...BACKGROUND The neutrophil to lymphocyte ratio(NLR)has been reported as a novel predictor for atherosclerosis and car-diovascular outcomes.This study aimed to determine the effects of NLR on long-term clinical outcomes of chronic total occlusion(CTO)patients.METHODS A total of 670 patients with CTO who met the inclusion criteria were included at the end of the follow-up period.Patients were divided into tertiles according to their baseline NLR levels at admission:low(n=223),intermediate(n=223),and high(n=224).The incidence of major adverse cardiac events(MACEs)during the follow-up period,including all-cause death,nonfatal myocardial infarction(MI),or ischemia-driven revascularization,were compared among the three groups.RESULTS Major adverse cardiac events were observed in 27 patients(12.1%)in the low tertile,40(17.9%)in the intermediate tertile,and 61(27.2%)in the high NLR tertile(P<0.001).Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE,ischemia-driven coronary revascularization,non-fatal MI,and mortality in patients within the high tertile than those in the low and intermediate groups(all P<0.001).Multivariable COX regression analysis showed that the high tertile of baseline NLR level showed a strong association with the risk of MACE(hazard ratio[HR]=2.21;95%confidence interval[CI]:1.21-4.03;P=0.009),ischemia-driven coronary revascularization(HR=3.19;95%CI:1.56-6.52;P=0.001),MI(HR=2.61;95%CI:1.35-5.03;P=0.043)and mortality(HR=3.78;95%CI:1.65-8.77;P=0.001).CONCLUSION Our findings suggest that NLR is an inexpensive and readily available biomarker that can independently pre-dict cardiovascular risk in patients with CTO.展开更多
BACKGROUND Myocardial infarction(MI)is a critical cardiovascular event with multifaceted etiology,involving several genetic and environmental factors.It is essential to understand the function of plasma metabolites in...BACKGROUND Myocardial infarction(MI)is a critical cardiovascular event with multifaceted etiology,involving several genetic and environmental factors.It is essential to understand the function of plasma metabolites in the development of MI and unravel its complex pathogenesis.METHODS This study employed a bidirectional Mendelian randomization(MR)approach to investigate the causal relationships between plasma metabolites and MI risk.We used genetic instruments as proxies for plasma metabolites and MI and conducted MR analyses in both directions to assess the impact of metabolites on MI risk and vice versa.In addition,the large-scale genome-wide association studies datasets was used to identify genetic variants associated with plasma metabolite(1400 metabolites)and MI(20,917 individuals with MI and 440,906 individuals without MI)susceptibility.Inverse variance weighted was the primary method for estimating causal effects.MR estimates are expressed as beta coefficients or odds ratio(OR)with 95%CI.RESULTS We identified 14 plasma metabolites associated with the occurrence of MI(P<0.05),among which 8 plasma metabolites[propionylglycine levels(OR=0.922,95%CI:0.881–0.965,P<0.001),gamma-glutamylglycine levels(OR=0.903,95%CI:0.861–0.948,P<0.001),hexadecanedioate(C16-DC)levels(OR=0.941,95%CI:0.911–0.973,P<0.001),pentose acid levels(OR=0.923,95%CI:0.877–0.972,P=0.002),X-24546 levels(OR=0.936,95%CI:0.902–0.971,P<0.001),glycine levels(OR=0.936,95%CI:0.909–0.964,P<0.001),glycine to serine ratio(OR=0.930,95%CI:0.888–0.974,P=0.002),and mannose to trans-4-hydroxyproline ratio(OR=0.912,95%CI:0.869–0.958,P<0.001)]were correlated with a decreased risk of MI,whereas the remaining 6 plasma metabolites[1-palmitoyl-2-arachidonoyl-GPE(16:0/20:4)levels(OR=1.051,95%CI:1.018–1.084,P=0.002),behenoyl dihydrosphingomyelin(d18:0/22:0)levels(OR=1.076,95%CI:1.027–1.128,P=0.002),1-stearoyl-2-docosahexaenoyl-GPE(18:0/22:6)levels(OR=1.067,95%CI:1.027–1.109,P=0.001),alpha-ketobutyrate levels(OR=1.108,95%CI:1.041–1.180,P=0.001),5-acetylamino-6-formylamino-3-methyluracil levels(OR=1.047,95%CI:1.019–1.076,P<0.001),and N-acetylputrescine to(N(1)+N(8))-acetylspermidine ratio(OR=1.045,95%CI:1.018–1.073,P<0.001)]were associated with an increased risk of MI.Furthermore,we also observed that the mentioned relationships were unaffected by horizontal pleiotropy(P>0.05).On the contrary,MI did not lead to significant alterations in the levels of the aforementioned 14 plasma metabolites(P>0.05 for each comparison).CONCLUSIONS Our bidirectional MR study identified 14 plasma metabolites associated with the occurrence of MI,among which 13 plasma metabolites have not been reported previously.These findings provide valuable insights for the early diagnosis of MI and potential therapeutic targets.展开更多
Objective We performed experiments using Neuregulin-1β （NRG-1β） treatment to determine a mechanism for the protective role derived from its beneficial effects by remodeling gap junctions （GJs） during heart failu...Objective We performed experiments using Neuregulin-1β （NRG-1β） treatment to determine a mechanism for the protective role derived from its beneficial effects by remodeling gap junctions （GJs） during heart failure （HF）. Methods Rat models of I-IF were established by aortocaval fistula. Forty-eight rats were divided randomly into the HF （HF, n = 16）, NRG-1β trealanent （NRG, n = 16）, and sham operation （S, n = 16） group. The rats in the NRG group were administered NRG-1β （10 μg/kg per day） for 7 days via the tail vein, whereas the other groups were injected with the same doses of saline, Twelve weeks after operation, Connexin 43 （Cx43） expression in single myocytes obtained from the left ventricle was determined by immunocytochemistry. Total protein was extracted from frozen left ventricular tissues for immunoblotting assay, and the ultrastmcture of myocytes was observed by transmission electron microscopy. Results Compared with the HF group, the cardiac fimction of rats in the NRG group was markedly improved, irregular distribution and deceased Cx43 expression were relieved. The ultrastmcture of myocytes was seriously damaged in HF rats, and NRG-1β reduced these pathological damages. Conclusions Short-term NRG-1β treatment can rescue pump failure in experimental models of volume overload-induced HF, which is related to the recovery of GJs structure and the improvement of Cx43 expression.展开更多
Recent nationwide clinico-epidemiological surveys in Japan showed that the occurrence of cardiomyopathies was most frequently seen in the age of sixties, and that cardiomyopathies are important causes of heart failure...Recent nationwide clinico-epidemiological surveys in Japan showed that the occurrence of cardiomyopathies was most frequently seen in the age of sixties, and that cardiomyopathies are important causes of heart failure in the elderly. Viral infection was conventionally considered to cause myocarditis, which resulted in the development of dilated cardiomyopathy. Recent studies suggest that hepatitis C virus (HCV) is involved in the development of dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy in addition to myocarditis. Furthermore, left ventricular aneurysm represents the same morbid state not only after myocardial infarction but also after myocarditis. There were wide variations in the frequency of detection of HCV genomes in cardiomyopathy in different regions and in different populations. Major histocompatibility complex class Ⅱ genes may play a role in the susceptibility to HCV infection, and may influence the development of different phenotypes of cardiomyopathy. If in fact the myocardial damage is caused by HCV, it might be expected that interferon (IFN) administration would be useful for its treatment. Hepatitis patients receiving IFN treatment for hepatitis were screened by thallium myocardial scintigraphy, and an abnormality was discovered in half of the patients. Treatment with IFN resulted in a disappearance of the image abnormality. It has thus been suggested that mild myocarditis and myocardial damage may be cured with IFN. We have recently found that high concentrations of circulating cardiac troponin T are a specific marker of cardiac involvement in HCV infection. By measuring cardiac troponin T in patients with HCV infection, the prevalence of cardiac involvement in HCV infection will be clarified. We are proposing a collaborative work on a global network on myocarditis/cardiomyopathies due to HCV infection. (J Geriatr Cardiol 2004;1(2):83-89. )展开更多
Background Diabetes is often associated with coronary artery disease,leading to adverse clinical outcomes.Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiograph...Background Diabetes is often associated with coronary artery disease,leading to adverse clinical outcomes.Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiography on the risk for late or repeated coronary revascularization and mortality.Methods Retrospective analysis of 1,353 consecutive patients>80 years who were admitted to the cardiac unit and further underwent coronary angiography.Subsequent revascularization procedures and all-cause mortality were recorded over a median fbllow-up of 47 months and their relation to diabetic status and presentation with acute coronary syndrome(ACS)was studied.Results Diabetes was present in 31%of the patients undergoing coronary angiography,and was associated with higher rates of obesity,hypertension,hyperlipidemia,chronic kidney disease and female gender.ACS was the presenting diagnosis in 71%of the patients and was associated with worse survival(1-year mortality 20%in ACS vs.6.2%in non-ACS patients,P<0.0001).Increase in long-term mortality rates was seen in diabetic subjects compared to non-diabetic subjects presenting with ACS(log-rank P=0.005),but not in the non-ACS setting(P=0」99).In a multivariable model,additionally adjusting for acuity of presentation,the presence of diabetes was associated with an adjusted hazard ratio of 1.60(95%confidence interval:12-2.28),P=0.011,for the need of late or repeat coronary revascularization and 1.48(1.26-1.74),P<0.0001 for all-cause mortality,during long-term follow-up.Conclusions In very old patients undergoing coronary angiography,presentation with ACS was associated with worse survival.Diabetes was an independent predictor of late or repeated revascularization and long-term mortality.展开更多
Background Uncertainty remains regarding the association between body mass index(BMI)and the risk of bleeding in patients with non-valvular atrial fibrillation(NVAF).We aimed to investigate the association between BMI...Background Uncertainty remains regarding the association between body mass index(BMI)and the risk of bleeding in patients with non-valvular atrial fibrillation(NVAF).We aimed to investigate the association between BMI and the risk of bleeding in elderly NVAF patients taking dabigatran.Methods A total of 509 elderly NVAF patients,who were being treated at twelve centers in China from February 2015 to December 2017 and taking dabigatran,were analyzed.The exposure and outcome variables were BMI at baseline and bleeding events within the subsequent six months,respectively.Cox proportional hazards regression analysis was used to evaluate the association between BMI and the risk of bleeding.Moreover,the Cox proportional hazards regression with cubic spline functions and smooth curve fitting was conducted.Results During the six-month follow-up,50 participants experienced bleeding.Every 1 kg/m^2 increase in BMI was associated with a 12%increased risk of bleeding(P=0.021).Compared to those with BMI values in Tertile 1(<22.5 kg/m^2),the adjusted hazard ratio(HR)of bleeding for participants in Tertile 2(22.5–25.3 kg/m^2)and Tertile 3(>25.3 kg/m^2)were 2.71(95%CI:1.02–7.17)and 3.5(95%CI:1.21–8.70),respectively.The Ptrend-value was significant in all models.The adjusted smooth curve showed a linear association between BMI and bleeding.None of the stratified variables showed significant effect modification on the association between BMI and bleeding(Pinteraction>0.05).Conclusions BMI was significantly and positively associated with the risk of bleeding in elderly NVAF patients treated with dabigatran.展开更多
Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ...Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride展开更多
Glucagon-like peptide-1 receptor agonists(GLP-1RAs)and dipeptidyl peptidase-4 inhibitors are commonly used treatments for patients with type 2 diabetes mellitus(T2DM).Both anti-diabetic treatments function by playing ...Glucagon-like peptide-1 receptor agonists(GLP-1RAs)and dipeptidyl peptidase-4 inhibitors are commonly used treatments for patients with type 2 diabetes mellitus(T2DM).Both anti-diabetic treatments function by playing key modulatory roles in the incretin system.Though these drugs have been deemed effective in treating T2DM,the Food and Drug Administration(FDA)and some members of the scientific community have questioned the safety of these therapeutics relative to important cardiovascular endpoints.As a result,since 2008,the FDA has required all new drugs for glycemic control in T2DM patients to demonstrate cardiovascular safety.The present review article strives to assess the safety and benefits of incretin-based therapy,a new class of antidiabetic drug,on the health of patient cardiovascular systems.In the process,this review will also provide a physiological overview of the incretin system and how key components function in T2DM.展开更多
BACKGROUD Acute heart failure with preserved ejection fraction(HFpEF)is a common but poorly studied cause of hospital admissions among nonagenarians.This study aimed to evaluate predictors of thirty-day readmission,in...BACKGROUD Acute heart failure with preserved ejection fraction(HFpEF)is a common but poorly studied cause of hospital admissions among nonagenarians.This study aimed to evaluate predictors of thirty-day readmission,in-hospital mortality,length of stay,and hospital charges in nonagenarians hospitalized with acute HFpEF.METHODS Patients hospitalized between January 2016 and December 2018 with a primary diagnosis of diastolic heart failure were identified using ICD-10 within the Nationwide Readmission Database.We excluded patients who died in index admission,and discharged in December each year to allow thirty-day follow-up.Univariate regression was performed on each variable.Vari-ables with P-value<0.2 were included in the multivariate regression model.RESULTS From a total of 45,393 index admissions,43,646 patients(96.2%)survived to discharge.A total of 7,437 patients(15.6%)had a thirty-day readmission.Mean cost of readmission was 43,265 United States dollars(USD)per patient.Significant predictors of thirty-day readmission were chronic kidney disease stage III or higher[adjusted odds ratio(aOR)=1.20,95%CI:1.07−1.34,P=0.002]and diabetes mellitus(aOR=1.18,95%CI:1.07−1.29,P=0.001).Meanwhile,female(aOR=0.90,95%CI:0.82−0.99,P=0.028)and palliative care encounter(aOR=0.27,95%CI:0.21−0.34,P<0.001)were associated with lower odds of readmission.Cardiac arrhythmia(aOR=1.46,95%CI:1.11−1.93,P=0.007)and aortic stenosis(aOR=1.36,95%CI:1.05−1.76,P=0.020)were amongst predictors of in-hospital mortality.CONCLUSIONS In nonagenarians hospitalized with acute HFpEF,thirty-day readmission is common and costly.Chronic co-morbidities predict poor outcomes.Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.展开更多
BACKGROUND Alcohol consumption is a known modifiable risk factor for atrial fibrillation.The association,however,might differ according to gender.We investigated gender-specific associations between alcohol consumptio...BACKGROUND Alcohol consumption is a known modifiable risk factor for atrial fibrillation.The association,however,might differ according to gender.We investigated gender-specific associations between alcohol consumption and incident atrial fibrillation in an elderly Chinese population.METHODS Our study participants were elderly residents(≥65 years)recruited from five community health centers in the urban area of Shanghai(n=6,618).Alcohol intake was classified as never drinkers and current light-to-moderate(<40 g/day)and heavy drinkers(≥40 g/day).Atrial fibrillation was detected by a 30-s single-lead electrocardiography(ECG,AliveCor®Heart Monitor)and further evaluated with a regular 12-lead ECG.RESULTS During a median of 2.1 years(interquartile range:2.0−2.2)follow-up,the incidence rate of atrial fibrillation was 1.10%in all study participants.It was slightly but non-significantly higher in men(n=2849)than women(n=3769,1.30%vs.0.96%,P=0.19)and in current drinkers(n=793)than never drinkers(n=5825,1.64%vs.1.03%,P=0.12).In both unadjusted and adjusted analyses,there was interaction between sex and current alcohol intake in relation to the incidence of atrial fibrillation(P<0.0001).After adjustment for confounding factors,current drinkers had a significantly higher incidence rate of atrial fibrillation than never drinkers in women(12.96%[7/54]vs.0.78%[29/3715],adjusted odds ratio[OR]=10.25,95%confidence interval[CI]:3.54−29.67,P<0.0001),but not in men(0.81%[6/739]vs.1.47%[31/2110],OR=0.62,95%CI:0.25−1.51,P=0.29).CONCLUSIONS Our study showed a significant association between alcohol intake and the incidence of atrial fibrillation in elderly Chinese women,but not men.展开更多
Objective: To estimate the effect of statins use on the prevention of venous thromboembolism (VTE). Methods: We systematically searched MEDLINE (1980-June 2012), EMBASE (1980-June 2012), Google Scholar, Cochrane Libra...Objective: To estimate the effect of statins use on the prevention of venous thromboembolism (VTE). Methods: We systematically searched MEDLINE (1980-June 2012), EMBASE (1980-June 2012), Google Scholar, Cochrane Library, and ISI Web of Science, manually reviewed references, and contacted experts. Case-control studies and cohort studies that compared any dose of statin with no statin or placebo are included. Data extraction and study quality evaluation were independently conducted in duplicate. Results: 12 studies including four cohort studies and eight case-control studies were identified and eligible for meta-analysis. Upon meta-analysis, statin use was associated with a statistically significant reduction in the odds of developing VTE (OR 0.91, 95% CI 0.86-0.96). Conclusion: This meta-analysis of current and available literature suggests that statins can reduce patient's risk of developing VTE. Due to the limitations of observational study, this conclusion should be considered with caution, and additionally, specifical well-designed trials are needed.展开更多
Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from t...Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.展开更多
Objective： To construct a human ether-a-go-go-related gene （HERG） nonsense mutant L539fs/47-558W into the autonomously fluorescent, eukaryotic expression vector pEGFP-C2, and to verify expression of the reconstruct...Objective： To construct a human ether-a-go-go-related gene （HERG） nonsense mutant L539fs/47-558W into the autonomously fluorescent, eukaryotic expression vector pEGFP-C2, and to verify expression of the reconstruct in human embryonic kidney-293 （HEK293） cells. Methods： The mutational fragment was subcloned into pEGFP-C2-HERG by double digestion of Sbf I, Eco91 1 and rejoining of T4 ligase. After verification, the recombinant pEGFP-C2-L539fs/47-558W and pEGFP-C2-HERG were respectively transfected into HEK293 cells for 48 h by the Lipofect method to observe the expression location of the fusion protein by laser confocal imaging scanning in vivo. pcDNA3 -L539fs/47-＊558W and pcDNA3-HERG were transfected to observe the expression location of the HERG protein by immunofluoresceoce. The mutant protein size was determined by Western blotting. Results： The about 1 kb-sized mutation region cDNA fragment from pcDNA3-L539fs/47-＊558Wand the about 7.2 kb-sized target vector fragment from pcDNA3-HERG were ligated after purification and gel recovery pEGFP-C2-L539fs/47＊-558W, approximately 8.2 kb, was demonstrated successfully been constructed under agarose gel electrophoresis and further sequencing. Laser confocal imaging showed that pEGFP-C2-HERG was mainly expressed in the membrane, whereas truncated mutant-type HERG in the pEGFP-C2 vector was partially located in the cytoplasm, the others were transported to the cell membrane in living HEK293 cells. The same as the immunofluoresceoce results after transfection of pcDNA3-HERG and pcDNA3-L539fs/47-558W. Wild-type HERG-GFP fusion protein expressed 160 and 180 kDa bands. The mutant and mutant-GFP fusion proteins were 70 and 100 kDa, respectively. Conclusion： pEGFP-C2-L539fs/47-＊558W was successfully constructed by double digestion method GFP had no effect on its protein expression and trafficking in HEK293 cells, which laid a foundation for the further study on L539fs/47-＊558W展开更多
Background Pulmonary veins （PV） and the atria undergo electrical and structural remodeling in atrial fibrillation （AF）. This study aimed to determine PV and left atrial （LA） reverse remodeling after catheter abl...Background Pulmonary veins （PV） and the atria undergo electrical and structural remodeling in atrial fibrillation （AF）. This study aimed to determine PV and left atrial （LA） reverse remodeling after catheter ablation for AF assessed by chest computed tomography （CT）. Methods PV electrophysiologic studies and catheter ablation were performed in 63 patients （68% male; mean ± SD age： 56 ± 10 years） with symptomatic AF （49% paroxysmal, 51% persistent）. Chest CT was performed before and 3 months after catheter ablation. Results At baseline, patients with persistent AF had a greater LA volume （91 ±29 cm3 vs. 66 ± 27 cm3; P = 0.003） and mean PV ostial area （241 ＋ 43 mm2 vs. 212 ± 47 mm2; P = 0.03） than patients with paroxysmal AF. There was no significant correlation between the effective refractory period and the area of the left superior PV ostium. At 3 months of follow-up after ablation, 48 patients （76%） were AF free on or off antiarrhythmic drugs. There was a significant reduction in LA volume （77 ±31 cm3 to 70 ± 28 cm3; P 〈 0.001） and mean PV ostial area （224 ± 48 mm2 to 182 ± 43 mm2; P 〈 0.001）. Patients with persistent AF had more reduction in LA volume （11.8 ± 12.8 cm3 vs. 4.0 ± 11.2 cm3; P = 0.04） and PV ostial area （62 mm2 vs. 34 mm2; P = 0.04） than those who have paroxysmal AF. The reduction of the averaged PV ostial area was significantly correlated with the reduction of LA volume （r = 0.38, P = 0.03）. Conclusions Catheter ablation of AF improves structural remodeling ofPV ostia and left atrium. This finding is more apparent in patients with persistent AF treated by catheter ablation.展开更多
OBJECTIVE To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.METHODS Our study participants were elderly(≥60 years)men recruited in a suburban town of S...OBJECTIVE To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.METHODS Our study participants were elderly(≥60 years)men recruited in a suburban town of Shanghai.Cigarette smoking status was categorized as never smoking,remote(cessation>5 years)and recent former smoking(cessation≤5 years),and light-to-moderate(≤20 cigarettes/day)and heavy current smoking(>20 cigarettes/day).Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest.RESULTS The 1568 participants had a mean age of 68.6±7.1 years.Of all participants,311 were never smokers,201 were remote former smokers,133 were recent former smokers,783 were light-to-moderate current smokers and 140 were heavy current smokers.During a median follow-up of 7.9 years,all-cause,cardiovascular and non-cardiovascular deaths occurred in 267,106 and 161 participants,respectively.Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality,with an adjusted hazard ratio(HR)of 2.30(95%CI:1.34-4.07)and 3.98(95%CI:2.03-7.83)versus never smokers,respectively.Recent former smokers also had a higher risk of all-cause(HR=1.62,95%CI:1.04-2.52)and non-cardiovascular mortality(HR=2.40,95%CI:1.32-4.37)than never smokers.Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter.Further subgroup analyses showed interaction between smoking status and pulse rate(≥70 beats/min vs.<70 beats/min)in relation to the risk of all-cause and non-cardiovascular mortality,with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min.CONCLUSIONS Cigarette smoking in elderly Chinese confers significant risks of mortality,especially when recent former smoking is considered together with current smoking.展开更多
BACKGROUND Controversy exists as to the optimal treatment approach for ostial left anterior descending(LAD)or ostial left circumflex artery(LCx)lesions.Drug-coated balloons(DCB)may overcome some of the limitations of ...BACKGROUND Controversy exists as to the optimal treatment approach for ostial left anterior descending(LAD)or ostial left circumflex artery(LCx)lesions.Drug-coated balloons(DCB)may overcome some of the limitations of drug-eluting stents(DES).Therefore,we investigated the security and feasibility of the DCB policy in patients with ostial LAD or ostial LCx lesions,and compared it with the conventional DES-only strategy.METHODS We retrospectively enrolled patients with de novo ostial lesions in the LAD or LCx who underwent interventional treatment.They were categorized into two groups based on their treatment approach:the DCB group and the DES group.The treatment strategies in the DCB group involved the use of either DCB-only or hybrid strategies,whereas the DES group utilized crossover or precise stenting techniques.Two-year target lesion revascularization was the primary endpoint,while the rates of major adverse cardiovascular events,cardiac death,target vessel myocardial infarction,and vessel thrombosis were the secondary endpoints.Using propensity score matching,we assembled a cohort with comparable baseline characteristics.To ensure result analysis reliability,we conducted sensitivity analyses,including interaction,and stratified analyses.RESULTS Among the 397 eligible patients,6.25%of patients who were planned to undergo DCB underwent DES.A total of 108 patients in each group had comparable propensity scores and were included in the analysis.Two-year target lesion revascularization occurred in 5 patients(4.90%)and 16 patients(16.33%)in the DCB group and the DES group,respectively(odds ratio=0.264,95%CI:0.093–0.752,P=0.008).Compared with the DES group,the DCB group demonstrated a lower major adverse cardiovascular events rate(7.84%vs.19.39%,P=0.017).However,differences with regard to cardiac death,non-periprocedural target vessel myocardial infarction,and definite or probable vessel thrombosis between the groups were non-significant.CONCLUSIONS The utilization of the DCB approach signifies an innovative and discretionary strategy for managing isolated ostial lesions in the LAD or LCx.Nevertheless,a future randomized trial investigating the feasibility and safety of DCB compared to the DES-only strategy specifically for de novo ostial lesions in the LAD or LCx is highly warranted.展开更多
文摘Background Previous studies have extensively investigated traditional predictors of cardiovascular disease(CVD)development,progression,and prognosis.However,the influence of novel indicators such as Klotho,on CVD prevalence and prognosis in the general population remains unclear.Method This was an observational study that utilized cross-sectional and longitudinal methods to examine the general population in the National Health and Nutrition Examination Survey(NHANES)2007-2016.The participants were divided into four groups according to the Klotho quartiles.Primary outcome was CVD[coronary artery disease(CAD),congestive heart failure,and stroke],secondary outcomes were all-cause mortality and cardiovascular mortality.Survey-weighted binary logistic regression analysis was used to analyze the association between Klotho and the prevalence of primary outcome,and the restricted cubic spline(RCS)curve was used to further analyze the nonlinear relationship.Subgroup analyses were conducted to investigate the association between Klotho values and CVD prevalence using survey-weighted binary logistic regression.The incidence of the secondary outcomes among four groups was assessed through Kaplan-Meier survival analysis.Additionally,the relationship between Klotho values and secondary endpoints was explored using survey-weighted Cox proportional hazards regression across various patient subpopulations.Results A total of 12,146 participants(56.8±10.7 years,48.5%male)were included in our study.The total incidence of CVD was 9.9%(n=1201),of which 4.7%(n=574)were CAD,3.7%(n=454)were congestive heart failure,and 4.1%(n=497)were stroke.Binary logistics regression analysis showed that higher Klotho quartiles were associated with the decreased prevalence of CVD[Quartile 4 vs.Quartile 1:odds ratio(OR)(95%CI):0.77(0.64-0.93),P=0.006]and congestive heart failure[Quartile 4 vs.Quartile 1:0.75(0.56-0.99),P=0.048],However,no significant associations were found between Klotho levels and the outcomes of CAD or stroke.RCS curve illustrated a high Klotho value was negatively correlated with the prevalence of CVD(nonlinear P=0.838),congestive heart failure(nonlinear P=0.110)and stroke(nonlinear P=0.972).No significant interactions were observed in any subgroups regarding the associations between Klotho and prevalence of CVD.After a median follow-up period of 93 months(range:from 1 to 160 months),there were 1228 cases(10.1%)of all-cause mortality in the general population,including 296 cases(2.4%)of cardiovascular mortality.The Kaplan-Meier curves indicated that lower Klotho levels were associated with a significant increase in all-cause mortality across the general population,CVD population,and non-CVD population.As Klotho levels decreased,there was also a notable rise in cardiovascular mortality in both the general population and the CVD population.In the overall population,Cox regression analyses demonstrated that higher Klotho values were associated with a decreased risk of both all-cause and cardiovascular mortality.And no significant interaction was observed in the CVD subgroup regarding the association between Klotho and mortality.Conclusion High Klotho level was associated with low prevalence of CVD and low risk of mortality in general population.
基金supported by the National Natural Science Foundation of China(No.81960074)the Natural Science Foundation-Outstanding Youth Fund Project of Jiangxi Province(No.20232ACB216006)。
文摘BACKGROUND Oxidative stress is closely associated with hypertensive outcomes.The oxidative balance score(OBS)measures oxidative stress exposure from dietary and lifestyle elements.The objective of this study was to investigate the association between OBS and mortality in hypertensive patients.METHODS This study included 7823 hypertensive patients from the National Health and Nutrition Examination Survey(NHA-NES)1999-2014.Several models,including Cox regression,restricted cubic splines(RCS),Kaplan-Meier survival analysis,subgroup,and sensitivity analyses,were exploited to investigate the relationship between OBS and the risk of mortality.RESULTS Controlling for all potential confounders,a significantly inverse association was observed between elevated OBS and all-cause[hazard ratio(HR)=0.90,95%CI:0.85-0.95]and cardiovascular mortality(HR=0.85,95%CI:0.75-0.95).With adjustment for covariates,significant associations between lifestyle OBS and mortality risks diminished,whereas associations between dietary OBS and these mortality risks remained robust(all-cause mortality:HR=0.91,95%CI:0.86-0.96;cardiovascular mortality:HR=0.85,95%CI:0.76-0.96).RCS demonstrated a linear relationship between OBS and all-cause and cardiovascular mortality risk(P_(nonlinear)=0.088 and P_(nonlinear)=0.447,respectively).Kaplan-Meier curves demonstrated that the mortality rate was lower with a high OBS(P<0.001).The consistency of the association was demonstrated in subgroup and sensitivity analyses.RCS after stratification showed that among current drinkers,those with higher OBS had a lower risk of mortality compared with former or never drinkers.CONCLUSIONS In hypertensive individuals,there was a negative association between OBS and all-cause and cardiovascular mortality.Encouraging hypertensive individuals,especially those currently drinking,to maintain high levels of OBS may be beneficial in improving their prognosis.
基金supported by the Doctoral Scientific Research Foundation of the First Affiliated Hospital of USTC(RC2021023)Key Research and Development Plan of Anhui Province(S2022e07020194).
文摘Cardiac arrest(CA)is one of the most common causes of death.[1-3]Despite extensive studies on the management of CA,the global survival rate in adults is only approximately 7%,and 30-day survival is even less than 2%in China.[4]Some studies have shown that CA patients of cardiac and non-cardiac origin may differ in underlying diseases,clinical manifestations,and prognosis,which leads to diff erences in terms of the pathophysiological mechanism and treatment measure.[5,6]However,little is known about the risk factors in relation to the prognosis of CA across arrest etiologies.
基金supported by the National Natural Science Foundation of China(No.82360608)the Free Exploration Project of the Second Affiliated Hospital of Xi’an Jiaotong University(2020YJ153)。
文摘BACKGROUND Triglyceride-glucose(TyG)index values are a new surrogate marker for insulin resistance.This study aimed to explore the relationship between cumulative TyG index values and atrial fibrillation(AF)recurrence after radiofrequency catheter ablation(RFCA).METHODS A total of 576 patients with AF who underwent RFCA at the Second Affiliated Hospital of Xi'an Jiaotong University were included in this study.The participants were grouped based on cumulative TyG index values tertiles within 3 months after ablation.Cox regression and restricted cubic spline analyses were used to determine the relationship between cumulative TyG index values and AF recurrence.The predictive value of all risk factors was assessed by receiver operating curve analysis.RESULTS There were 375 patients completed the study(age:63.23±10.73 years,64.27%male).The risk of AF recurrence increased with increasing cumulative TyG index values tertiles.After adjusting for potential confounders,patients in the medium cumulative TyG index group[hazard ratio(HR)=4.949,95%CI:1.778–13.778,P=0.002]and the high cumulative TyG index group(HR=8.716,95%CI:3.371–22.536,P<0.001)had a higher risk of AF recurrence than those in the low cumulative TyG index group.The restricted cubic spline regression model also showed an increased risk of AF recurrence with increasing cumulative TyG index values.When considering cumulative TyG index values,left atrial diameter,and lactate dehydrogenase levels as a comprehensive factor,the model could effectively predict AF recurrence after RFCA[area under the curve(AUC)=0.847,95%CI:0.797–0.897,P<0.001].CONCLUSIONS Cumulative TyG index values were a risk factor for AF recurrence after RFCA.Monitoring longitudinal TyG index values may assist with optimized for risk stratification and outcome prediction for AF recurrence.
基金This work was supported by the National Natur-al Sciences Foundation of China(NSFC)(Grant NO.81970262)。
文摘BACKGROUND The neutrophil to lymphocyte ratio(NLR)has been reported as a novel predictor for atherosclerosis and car-diovascular outcomes.This study aimed to determine the effects of NLR on long-term clinical outcomes of chronic total occlusion(CTO)patients.METHODS A total of 670 patients with CTO who met the inclusion criteria were included at the end of the follow-up period.Patients were divided into tertiles according to their baseline NLR levels at admission:low(n=223),intermediate(n=223),and high(n=224).The incidence of major adverse cardiac events(MACEs)during the follow-up period,including all-cause death,nonfatal myocardial infarction(MI),or ischemia-driven revascularization,were compared among the three groups.RESULTS Major adverse cardiac events were observed in 27 patients(12.1%)in the low tertile,40(17.9%)in the intermediate tertile,and 61(27.2%)in the high NLR tertile(P<0.001).Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE,ischemia-driven coronary revascularization,non-fatal MI,and mortality in patients within the high tertile than those in the low and intermediate groups(all P<0.001).Multivariable COX regression analysis showed that the high tertile of baseline NLR level showed a strong association with the risk of MACE(hazard ratio[HR]=2.21;95%confidence interval[CI]:1.21-4.03;P=0.009),ischemia-driven coronary revascularization(HR=3.19;95%CI:1.56-6.52;P=0.001),MI(HR=2.61;95%CI:1.35-5.03;P=0.043)and mortality(HR=3.78;95%CI:1.65-8.77;P=0.001).CONCLUSION Our findings suggest that NLR is an inexpensive and readily available biomarker that can independently pre-dict cardiovascular risk in patients with CTO.
基金supported by the Guangxi Natural Science Foundation(No.2020GXNSFDA238007)the Key Research and Development Program of Guangxi(No.2023AB22024)the Chongzuo Science and Technology Bureau Planning Project(No.FA2018026)。
文摘BACKGROUND Myocardial infarction(MI)is a critical cardiovascular event with multifaceted etiology,involving several genetic and environmental factors.It is essential to understand the function of plasma metabolites in the development of MI and unravel its complex pathogenesis.METHODS This study employed a bidirectional Mendelian randomization(MR)approach to investigate the causal relationships between plasma metabolites and MI risk.We used genetic instruments as proxies for plasma metabolites and MI and conducted MR analyses in both directions to assess the impact of metabolites on MI risk and vice versa.In addition,the large-scale genome-wide association studies datasets was used to identify genetic variants associated with plasma metabolite(1400 metabolites)and MI(20,917 individuals with MI and 440,906 individuals without MI)susceptibility.Inverse variance weighted was the primary method for estimating causal effects.MR estimates are expressed as beta coefficients or odds ratio(OR)with 95%CI.RESULTS We identified 14 plasma metabolites associated with the occurrence of MI(P<0.05),among which 8 plasma metabolites[propionylglycine levels(OR=0.922,95%CI:0.881–0.965,P<0.001),gamma-glutamylglycine levels(OR=0.903,95%CI:0.861–0.948,P<0.001),hexadecanedioate(C16-DC)levels(OR=0.941,95%CI:0.911–0.973,P<0.001),pentose acid levels(OR=0.923,95%CI:0.877–0.972,P=0.002),X-24546 levels(OR=0.936,95%CI:0.902–0.971,P<0.001),glycine levels(OR=0.936,95%CI:0.909–0.964,P<0.001),glycine to serine ratio(OR=0.930,95%CI:0.888–0.974,P=0.002),and mannose to trans-4-hydroxyproline ratio(OR=0.912,95%CI:0.869–0.958,P<0.001)]were correlated with a decreased risk of MI,whereas the remaining 6 plasma metabolites[1-palmitoyl-2-arachidonoyl-GPE(16:0/20:4)levels(OR=1.051,95%CI:1.018–1.084,P=0.002),behenoyl dihydrosphingomyelin(d18:0/22:0)levels(OR=1.076,95%CI:1.027–1.128,P=0.002),1-stearoyl-2-docosahexaenoyl-GPE(18:0/22:6)levels(OR=1.067,95%CI:1.027–1.109,P=0.001),alpha-ketobutyrate levels(OR=1.108,95%CI:1.041–1.180,P=0.001),5-acetylamino-6-formylamino-3-methyluracil levels(OR=1.047,95%CI:1.019–1.076,P<0.001),and N-acetylputrescine to(N(1)+N(8))-acetylspermidine ratio(OR=1.045,95%CI:1.018–1.073,P<0.001)]were associated with an increased risk of MI.Furthermore,we also observed that the mentioned relationships were unaffected by horizontal pleiotropy(P>0.05).On the contrary,MI did not lead to significant alterations in the levels of the aforementioned 14 plasma metabolites(P>0.05 for each comparison).CONCLUSIONS Our bidirectional MR study identified 14 plasma metabolites associated with the occurrence of MI,among which 13 plasma metabolites have not been reported previously.These findings provide valuable insights for the early diagnosis of MI and potential therapeutic targets.
基金This research was supported by the Key Program，the National Natural Science Foundation of China
文摘Objective We performed experiments using Neuregulin-1β （NRG-1β） treatment to determine a mechanism for the protective role derived from its beneficial effects by remodeling gap junctions （GJs） during heart failure （HF）. Methods Rat models of I-IF were established by aortocaval fistula. Forty-eight rats were divided randomly into the HF （HF, n = 16）, NRG-1β trealanent （NRG, n = 16）, and sham operation （S, n = 16） group. The rats in the NRG group were administered NRG-1β （10 μg/kg per day） for 7 days via the tail vein, whereas the other groups were injected with the same doses of saline, Twelve weeks after operation, Connexin 43 （Cx43） expression in single myocytes obtained from the left ventricle was determined by immunocytochemistry. Total protein was extracted from frozen left ventricular tissues for immunoblotting assay, and the ultrastmcture of myocytes was observed by transmission electron microscopy. Results Compared with the HF group, the cardiac fimction of rats in the NRG group was markedly improved, irregular distribution and deceased Cx43 expression were relieved. The ultrastmcture of myocytes was seriously damaged in HF rats, and NRG-1β reduced these pathological damages. Conclusions Short-term NRG-1β treatment can rescue pump failure in experimental models of volume overload-induced HF, which is related to the recovery of GJs structure and the improvement of Cx43 expression.
文摘Recent nationwide clinico-epidemiological surveys in Japan showed that the occurrence of cardiomyopathies was most frequently seen in the age of sixties, and that cardiomyopathies are important causes of heart failure in the elderly. Viral infection was conventionally considered to cause myocarditis, which resulted in the development of dilated cardiomyopathy. Recent studies suggest that hepatitis C virus (HCV) is involved in the development of dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy in addition to myocarditis. Furthermore, left ventricular aneurysm represents the same morbid state not only after myocardial infarction but also after myocarditis. There were wide variations in the frequency of detection of HCV genomes in cardiomyopathy in different regions and in different populations. Major histocompatibility complex class Ⅱ genes may play a role in the susceptibility to HCV infection, and may influence the development of different phenotypes of cardiomyopathy. If in fact the myocardial damage is caused by HCV, it might be expected that interferon (IFN) administration would be useful for its treatment. Hepatitis patients receiving IFN treatment for hepatitis were screened by thallium myocardial scintigraphy, and an abnormality was discovered in half of the patients. Treatment with IFN resulted in a disappearance of the image abnormality. It has thus been suggested that mild myocarditis and myocardial damage may be cured with IFN. We have recently found that high concentrations of circulating cardiac troponin T are a specific marker of cardiac involvement in HCV infection. By measuring cardiac troponin T in patients with HCV infection, the prevalence of cardiac involvement in HCV infection will be clarified. We are proposing a collaborative work on a global network on myocarditis/cardiomyopathies due to HCV infection. (J Geriatr Cardiol 2004;1(2):83-89. )
文摘Background Diabetes is often associated with coronary artery disease,leading to adverse clinical outcomes.Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiography on the risk for late or repeated coronary revascularization and mortality.Methods Retrospective analysis of 1,353 consecutive patients>80 years who were admitted to the cardiac unit and further underwent coronary angiography.Subsequent revascularization procedures and all-cause mortality were recorded over a median fbllow-up of 47 months and their relation to diabetic status and presentation with acute coronary syndrome(ACS)was studied.Results Diabetes was present in 31%of the patients undergoing coronary angiography,and was associated with higher rates of obesity,hypertension,hyperlipidemia,chronic kidney disease and female gender.ACS was the presenting diagnosis in 71%of the patients and was associated with worse survival(1-year mortality 20%in ACS vs.6.2%in non-ACS patients,P<0.0001).Increase in long-term mortality rates was seen in diabetic subjects compared to non-diabetic subjects presenting with ACS(log-rank P=0.005),but not in the non-ACS setting(P=0」99).In a multivariable model,additionally adjusting for acuity of presentation,the presence of diabetes was associated with an adjusted hazard ratio of 1.60(95%confidence interval:12-2.28),P=0.011,for the need of late or repeat coronary revascularization and 1.48(1.26-1.74),P<0.0001 for all-cause mortality,during long-term follow-up.Conclusions In very old patients undergoing coronary angiography,presentation with ACS was associated with worse survival.Diabetes was an independent predictor of late or repeated revascularization and long-term mortality.
基金supported by the Major New Drug Creation Program from National Science and Technology Major Project of China(2014ZX09303305).
文摘Background Uncertainty remains regarding the association between body mass index(BMI)and the risk of bleeding in patients with non-valvular atrial fibrillation(NVAF).We aimed to investigate the association between BMI and the risk of bleeding in elderly NVAF patients taking dabigatran.Methods A total of 509 elderly NVAF patients,who were being treated at twelve centers in China from February 2015 to December 2017 and taking dabigatran,were analyzed.The exposure and outcome variables were BMI at baseline and bleeding events within the subsequent six months,respectively.Cox proportional hazards regression analysis was used to evaluate the association between BMI and the risk of bleeding.Moreover,the Cox proportional hazards regression with cubic spline functions and smooth curve fitting was conducted.Results During the six-month follow-up,50 participants experienced bleeding.Every 1 kg/m^2 increase in BMI was associated with a 12%increased risk of bleeding(P=0.021).Compared to those with BMI values in Tertile 1(<22.5 kg/m^2),the adjusted hazard ratio(HR)of bleeding for participants in Tertile 2(22.5–25.3 kg/m^2)and Tertile 3(>25.3 kg/m^2)were 2.71(95%CI:1.02–7.17)and 3.5(95%CI:1.21–8.70),respectively.The Ptrend-value was significant in all models.The adjusted smooth curve showed a linear association between BMI and bleeding.None of the stratified variables showed significant effect modification on the association between BMI and bleeding(Pinteraction>0.05).Conclusions BMI was significantly and positively associated with the risk of bleeding in elderly NVAF patients treated with dabigatran.
基金Supported by the National Natural and Science Foundation of China(30871042)
文摘Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride
基金supported by the National Natural Science Foundation of China(81974254,31870906,and 82170470)。
文摘Glucagon-like peptide-1 receptor agonists(GLP-1RAs)and dipeptidyl peptidase-4 inhibitors are commonly used treatments for patients with type 2 diabetes mellitus(T2DM).Both anti-diabetic treatments function by playing key modulatory roles in the incretin system.Though these drugs have been deemed effective in treating T2DM,the Food and Drug Administration(FDA)and some members of the scientific community have questioned the safety of these therapeutics relative to important cardiovascular endpoints.As a result,since 2008,the FDA has required all new drugs for glycemic control in T2DM patients to demonstrate cardiovascular safety.The present review article strives to assess the safety and benefits of incretin-based therapy,a new class of antidiabetic drug,on the health of patient cardiovascular systems.In the process,this review will also provide a physiological overview of the incretin system and how key components function in T2DM.
文摘BACKGROUD Acute heart failure with preserved ejection fraction(HFpEF)is a common but poorly studied cause of hospital admissions among nonagenarians.This study aimed to evaluate predictors of thirty-day readmission,in-hospital mortality,length of stay,and hospital charges in nonagenarians hospitalized with acute HFpEF.METHODS Patients hospitalized between January 2016 and December 2018 with a primary diagnosis of diastolic heart failure were identified using ICD-10 within the Nationwide Readmission Database.We excluded patients who died in index admission,and discharged in December each year to allow thirty-day follow-up.Univariate regression was performed on each variable.Vari-ables with P-value<0.2 were included in the multivariate regression model.RESULTS From a total of 45,393 index admissions,43,646 patients(96.2%)survived to discharge.A total of 7,437 patients(15.6%)had a thirty-day readmission.Mean cost of readmission was 43,265 United States dollars(USD)per patient.Significant predictors of thirty-day readmission were chronic kidney disease stage III or higher[adjusted odds ratio(aOR)=1.20,95%CI:1.07−1.34,P=0.002]and diabetes mellitus(aOR=1.18,95%CI:1.07−1.29,P=0.001).Meanwhile,female(aOR=0.90,95%CI:0.82−0.99,P=0.028)and palliative care encounter(aOR=0.27,95%CI:0.21−0.34,P<0.001)were associated with lower odds of readmission.Cardiac arrhythmia(aOR=1.46,95%CI:1.11−1.93,P=0.007)and aortic stenosis(aOR=1.36,95%CI:1.05−1.76,P=0.020)were amongst predictors of in-hospital mortality.CONCLUSIONS In nonagenarians hospitalized with acute HFpEF,thirty-day readmission is common and costly.Chronic co-morbidities predict poor outcomes.Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.
文摘BACKGROUND Alcohol consumption is a known modifiable risk factor for atrial fibrillation.The association,however,might differ according to gender.We investigated gender-specific associations between alcohol consumption and incident atrial fibrillation in an elderly Chinese population.METHODS Our study participants were elderly residents(≥65 years)recruited from five community health centers in the urban area of Shanghai(n=6,618).Alcohol intake was classified as never drinkers and current light-to-moderate(<40 g/day)and heavy drinkers(≥40 g/day).Atrial fibrillation was detected by a 30-s single-lead electrocardiography(ECG,AliveCor®Heart Monitor)and further evaluated with a regular 12-lead ECG.RESULTS During a median of 2.1 years(interquartile range:2.0−2.2)follow-up,the incidence rate of atrial fibrillation was 1.10%in all study participants.It was slightly but non-significantly higher in men(n=2849)than women(n=3769,1.30%vs.0.96%,P=0.19)and in current drinkers(n=793)than never drinkers(n=5825,1.64%vs.1.03%,P=0.12).In both unadjusted and adjusted analyses,there was interaction between sex and current alcohol intake in relation to the incidence of atrial fibrillation(P<0.0001).After adjustment for confounding factors,current drinkers had a significantly higher incidence rate of atrial fibrillation than never drinkers in women(12.96%[7/54]vs.0.78%[29/3715],adjusted odds ratio[OR]=10.25,95%confidence interval[CI]:3.54−29.67,P<0.0001),but not in men(0.81%[6/739]vs.1.47%[31/2110],OR=0.62,95%CI:0.25−1.51,P=0.29).CONCLUSIONS Our study showed a significant association between alcohol intake and the incidence of atrial fibrillation in elderly Chinese women,but not men.
文摘Objective: To estimate the effect of statins use on the prevention of venous thromboembolism (VTE). Methods: We systematically searched MEDLINE (1980-June 2012), EMBASE (1980-June 2012), Google Scholar, Cochrane Library, and ISI Web of Science, manually reviewed references, and contacted experts. Case-control studies and cohort studies that compared any dose of statin with no statin or placebo are included. Data extraction and study quality evaluation were independently conducted in duplicate. Results: 12 studies including four cohort studies and eight case-control studies were identified and eligible for meta-analysis. Upon meta-analysis, statin use was associated with a statistically significant reduction in the odds of developing VTE (OR 0.91, 95% CI 0.86-0.96). Conclusion: This meta-analysis of current and available literature suggests that statins can reduce patient's risk of developing VTE. Due to the limitations of observational study, this conclusion should be considered with caution, and additionally, specifical well-designed trials are needed.
文摘Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.
基金Supported by the National Natural Science Foundation of China(No.30800473)
文摘Objective： To construct a human ether-a-go-go-related gene （HERG） nonsense mutant L539fs/47-558W into the autonomously fluorescent, eukaryotic expression vector pEGFP-C2, and to verify expression of the reconstruct in human embryonic kidney-293 （HEK293） cells. Methods： The mutational fragment was subcloned into pEGFP-C2-HERG by double digestion of Sbf I, Eco91 1 and rejoining of T4 ligase. After verification, the recombinant pEGFP-C2-L539fs/47-558W and pEGFP-C2-HERG were respectively transfected into HEK293 cells for 48 h by the Lipofect method to observe the expression location of the fusion protein by laser confocal imaging scanning in vivo. pcDNA3 -L539fs/47-＊558W and pcDNA3-HERG were transfected to observe the expression location of the HERG protein by immunofluoresceoce. The mutant protein size was determined by Western blotting. Results： The about 1 kb-sized mutation region cDNA fragment from pcDNA3-L539fs/47-＊558Wand the about 7.2 kb-sized target vector fragment from pcDNA3-HERG were ligated after purification and gel recovery pEGFP-C2-L539fs/47＊-558W, approximately 8.2 kb, was demonstrated successfully been constructed under agarose gel electrophoresis and further sequencing. Laser confocal imaging showed that pEGFP-C2-HERG was mainly expressed in the membrane, whereas truncated mutant-type HERG in the pEGFP-C2 vector was partially located in the cytoplasm, the others were transported to the cell membrane in living HEK293 cells. The same as the immunofluoresceoce results after transfection of pcDNA3-HERG and pcDNA3-L539fs/47-558W. Wild-type HERG-GFP fusion protein expressed 160 and 180 kDa bands. The mutant and mutant-GFP fusion proteins were 70 and 100 kDa, respectively. Conclusion： pEGFP-C2-L539fs/47-＊558W was successfully constructed by double digestion method GFP had no effect on its protein expression and trafficking in HEK293 cells, which laid a foundation for the further study on L539fs/47-＊558W
文摘Background Pulmonary veins （PV） and the atria undergo electrical and structural remodeling in atrial fibrillation （AF）. This study aimed to determine PV and left atrial （LA） reverse remodeling after catheter ablation for AF assessed by chest computed tomography （CT）. Methods PV electrophysiologic studies and catheter ablation were performed in 63 patients （68% male; mean ± SD age： 56 ± 10 years） with symptomatic AF （49% paroxysmal, 51% persistent）. Chest CT was performed before and 3 months after catheter ablation. Results At baseline, patients with persistent AF had a greater LA volume （91 ±29 cm3 vs. 66 ± 27 cm3; P = 0.003） and mean PV ostial area （241 ＋ 43 mm2 vs. 212 ± 47 mm2; P = 0.03） than patients with paroxysmal AF. There was no significant correlation between the effective refractory period and the area of the left superior PV ostium. At 3 months of follow-up after ablation, 48 patients （76%） were AF free on or off antiarrhythmic drugs. There was a significant reduction in LA volume （77 ±31 cm3 to 70 ± 28 cm3; P 〈 0.001） and mean PV ostial area （224 ± 48 mm2 to 182 ± 43 mm2; P 〈 0.001）. Patients with persistent AF had more reduction in LA volume （11.8 ± 12.8 cm3 vs. 4.0 ± 11.2 cm3; P = 0.04） and PV ostial area （62 mm2 vs. 34 mm2; P = 0.04） than those who have paroxysmal AF. The reduction of the averaged PV ostial area was significantly correlated with the reduction of LA volume （r = 0.38, P = 0.03）. Conclusions Catheter ablation of AF improves structural remodeling ofPV ostia and left atrium. This finding is more apparent in patients with persistent AF treated by catheter ablation.
基金supported by the National Natural Science Foundation of China(No.91639203&No.82070435)the Ministry of Science and Technology,Beijing,China(2018YFC1704902&2022YFC3601302)+2 种基金the Shanghai Commissions of Science and Technology and Health(a special grant for“leading academics”)(No.19DZ2340200)the Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System Big Data and Artificial Intelligence Application,Shanghai,China(GWV-10.1-XK05)the Clinical Research Programme,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,China(No.2018CR010).
文摘OBJECTIVE To investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.METHODS Our study participants were elderly(≥60 years)men recruited in a suburban town of Shanghai.Cigarette smoking status was categorized as never smoking,remote(cessation>5 years)and recent former smoking(cessation≤5 years),and light-to-moderate(≤20 cigarettes/day)and heavy current smoking(>20 cigarettes/day).Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest.RESULTS The 1568 participants had a mean age of 68.6±7.1 years.Of all participants,311 were never smokers,201 were remote former smokers,133 were recent former smokers,783 were light-to-moderate current smokers and 140 were heavy current smokers.During a median follow-up of 7.9 years,all-cause,cardiovascular and non-cardiovascular deaths occurred in 267,106 and 161 participants,respectively.Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality,with an adjusted hazard ratio(HR)of 2.30(95%CI:1.34-4.07)and 3.98(95%CI:2.03-7.83)versus never smokers,respectively.Recent former smokers also had a higher risk of all-cause(HR=1.62,95%CI:1.04-2.52)and non-cardiovascular mortality(HR=2.40,95%CI:1.32-4.37)than never smokers.Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter.Further subgroup analyses showed interaction between smoking status and pulse rate(≥70 beats/min vs.<70 beats/min)in relation to the risk of all-cause and non-cardiovascular mortality,with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min.CONCLUSIONS Cigarette smoking in elderly Chinese confers significant risks of mortality,especially when recent former smoking is considered together with current smoking.
基金supported by the Medical Science and Technique Research Plan of He’nan Province(Provincial and Ministerial Co-construction Project)(SB201901027).
文摘BACKGROUND Controversy exists as to the optimal treatment approach for ostial left anterior descending(LAD)or ostial left circumflex artery(LCx)lesions.Drug-coated balloons(DCB)may overcome some of the limitations of drug-eluting stents(DES).Therefore,we investigated the security and feasibility of the DCB policy in patients with ostial LAD or ostial LCx lesions,and compared it with the conventional DES-only strategy.METHODS We retrospectively enrolled patients with de novo ostial lesions in the LAD or LCx who underwent interventional treatment.They were categorized into two groups based on their treatment approach:the DCB group and the DES group.The treatment strategies in the DCB group involved the use of either DCB-only or hybrid strategies,whereas the DES group utilized crossover or precise stenting techniques.Two-year target lesion revascularization was the primary endpoint,while the rates of major adverse cardiovascular events,cardiac death,target vessel myocardial infarction,and vessel thrombosis were the secondary endpoints.Using propensity score matching,we assembled a cohort with comparable baseline characteristics.To ensure result analysis reliability,we conducted sensitivity analyses,including interaction,and stratified analyses.RESULTS Among the 397 eligible patients,6.25%of patients who were planned to undergo DCB underwent DES.A total of 108 patients in each group had comparable propensity scores and were included in the analysis.Two-year target lesion revascularization occurred in 5 patients(4.90%)and 16 patients(16.33%)in the DCB group and the DES group,respectively(odds ratio=0.264,95%CI:0.093–0.752,P=0.008).Compared with the DES group,the DCB group demonstrated a lower major adverse cardiovascular events rate(7.84%vs.19.39%,P=0.017).However,differences with regard to cardiac death,non-periprocedural target vessel myocardial infarction,and definite or probable vessel thrombosis between the groups were non-significant.CONCLUSIONS The utilization of the DCB approach signifies an innovative and discretionary strategy for managing isolated ostial lesions in the LAD or LCx.Nevertheless,a future randomized trial investigating the feasibility and safety of DCB compared to the DES-only strategy specifically for de novo ostial lesions in the LAD or LCx is highly warranted.
