Comparative study of galectin-3 and B-type natriuretic peptide as biomarkers for the diagnosis of heart failure

Background Heart failure （HF） is a common disease with complex pathophysiological causes. The diagnosis of HF commonly relies on comprehensive analyses of medical history and symptoms, and results from echocardiography and biochemical tests. Galectin-3, a rela-tively new biomarker in HF, was approved by the US Food and Drug Administration in 2010 as a marker in the stratification of risk for HF. We assessed galectin-3 as a biomarker for HF diagnosis in patients with preserved ejection fraction （pEF） and compared its performance with that of B-type natriuretic peptide （BNP）. Methods Thirty-five pEF patients with HF （HFpEF group） and 43 pEF patients without HF （control group） were enrolled. Plasma levels of galectin-3 and BNP in HFpEF and control subjects were determined. Sensitivity, specificity, pre dictive values, and accuracy of galectin-3 and BNP as markers for HF diagnosis were calculated and compared. Results Levels of galec- tin-3 and BNP were 23.09 ±6.97 ng/mL and 270.46 ± 330.41 pg/mL in the HFpEF group, and 16.74 ± 2.75 ng/mL and 59.94 ± 29.93 pg/mL in the control group, respectively. Differences in levels of galectin-3 and BNP between the two groups were significant （P 〈 0.01）. As a bio- marker for HF diagnosis in study subjects, galectin-3 showed sensitivity and specificity of 94.3% and 65.1%, respectively, at a cutoff value of 17.8 ug/mL. BNP showed sensitivity and specificity of 77.1% and 90.7%, respectively, at a cutoff value of 100 pg/mL. Galectin-3 was a significantly more sensitive （P 〈 0.05） but less specific （P 〈 0.01） biomarker compared with BNP. Differences in positive predictive value, negative predictive value, and accuracy between galectin-3 and BNP markers were not significant （P 〉 0.05）. Areas under the receiver operating characteristic curve （95% confidence interval） were 0.891 （0.808-0.974） and 0.896 （0.809-0.984） for galectin-3 and BNP, respec- tively, with no significant difference between the two values （P 〉 0.05）. Conclusions The level of galectin-3 is significantly elevated in patients with HF. Galectin-3 and BNP are useful biomarkers for the diagnosis of HF in patients with pEF.

Repeated measurement of growth-differentiation factor-15in Chinese Han patients with post-myocardial infarction chronic heart failure

Background Growth-differentiation factor-15(GDF-15)is a promising prognostic biomarker in patients with chronic heart failure (CHF).Comparatively little is known about the value of repeated measurement of GDF-15with CI-IF in Chinese Han population.This study sought to identify the clinical value of repeated measurement of GDF-15in Chinese Han patients with post-myocardial infarction CHF. Methods In total,232consecutive Chinese Hart patients with post-myocardial infarction CHF were enrolled prospectively from January 2014to June 2016.The plasma concentration of GDF-15was determined on admission and over 12months.Patients were followed up for all-cause death and a composite outcome of major adverse cardiac events (MACE)included all-cause death,myocardial infarction and first heart failure (HF)re-hospitalization.Association with other clinical variables and adverse outcomes of repeated measurement of GDF-15 was explored.Results The median baseline GDF-15level was 2025ng/L.Baseline GDF-15was moderately associated with baseline N-terminal pro-B type nalriuretic peptide (NT-proBNP)(coefficient 0.561,P <0.001).During a median follow-up of 20months,there were 53deaths and 100MACE.GDF-I5remained an independent predictor of all-cause death (adjusted hazard ratio 1.826per 1Ln U,95%CI: 1.037-8.360;P =0.037)and MACE (adjusted hazard ratio 2.243per I Ln U,95%CI:1.181-1.775;P <0.001)adjusted for established risk factors.Repeated measurement of GDF-15was performed in 173survivals over 12months.Increase of GDF-15over 12months was associ- ated with dilatation of left ventricle and acted as an independent predictor of subsequent all-canse death (adjusted HR =3.164,95%CI: 1.245~.041;P =0.015).In the joint model,GDF-15was also shown to be a risk factor for all-cause death (HR =2.749,95%CI: 1.667-3.831;P <0.001)and MACE (FIR =2.434,95%CI:1.425-3.443;P <0.001).Conclusions Repeated measurements of GDF-15 have promising prognostic value of the risk of all-cause death in Chinese Han patients with CI-IF post-myocardial infarction.GDF-15may influence the post-myocardial infarction CI-IF through the path physiological pathway of myocardial remodeling.

High Serum Resistin Level may be an Indicator of the Severity of Coronary Disease in Acute Coronary Syndrome

Objective To investigate the correlation between serum resistin level, cardiovascular risk factors and severity of coronary disease in acute coronary syndrome （ACS）. Methods Alter evaluated by clinical history, electrocardiography, exercise tolerance tests, laboratory tests, and coronary angiography, 220 consecutive patients with suspected chest pain were divided into normal control group, stable angina pectoris （SAP） group, and ACS group, respectively. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cell count, high-sensitive C-reactive protein （hsCRP）, total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were compared among three groups. ELISA was used to detect serum resistin levels. Pearson＇s correlation coefficient analysis was used to assess association between resistin and other traditional cardiovascular risk factors. Multinomial logistic regression analyses were used to define the relationship between serum resistin level and SAP or ACS. Results Serum resistin level in ACS group （1.18±0.48 μg/L） was significantly higher than that in normal control and SAP groups （0.49±0.40 and 0.66±0.40 μg/L; P〈0.01）. Only in ACS group, increased serum resistin level was significantly correlated with hsCRP （r=0.262, P=0.004） and white blood cell count （r=0.347, P=0.001）. Furthermore, serum resistin levels showed a stepwise increase with the number increase of 〉 50% stenosed coronary vessels. Multinomial logistic regression test demonstrated that serum resistin was a strong risk factor for ACS （OR=29.132, 95 % CI： 10.939-77.581, P〈0.001）. Conclusion These findings suggested the potential role of resistin in atherosclerosis and especially its involvement in ACS.

Prevalence of cardiovascular disease in subjects hospitalized due to chronic obstructive pulmonary disease in Beijing from 2000 to 2010

Objectives To investigate the overall prevalence of cardiovascular disease （CVD） in subjects hospitalized for chronic obstructive pulmonary disease （COPD）,and explore the prevalence of the major CVD complications and trends in patients with COPD over a 10-year period.Methods Medical records in the PLA General Hospital,Beijing Union Medical College Hospital,and Beijing Hospital from 2000/01/01 to 2010/03/03 were retrospectively reviewed.A total of 4960 patients with COPD were reviewed in the study （3570 males,mean age,72.2 ± 10.5 years; 1390 females,mean age,72.0 ± 10.4 years）.Results The prevalence of CVD in COPD patients was 51.7％.The three most prevalent CVDs were ischemic heart disease （28.9％）,heart failure （19.6％）,and arrhythmia （12.6％）.During the 10-year study period,the prevalence of various CVDs in COPD patients showed a gradual increasing trend with increasing age.There was higher morbidity due to ischemic heart disease （P ＜ 0.01） in male COPD patients than in the female counterparts.However,heart failure （P ＜ 0.01）and hypertension （P ＜ 0.01） occurred less frequently in male COPD patients than in female COPD patients.Furthermore,the prevalence of ischemic heart disease decreased year by year.In addition to heart failure,various types of CVD complications in COPD patients tended to occur in younger subjects.The prevalence of all major types of CVD in women tended to increase year by year.Conclusions The prevalence of CVD in patients hospitalized for COPD in Beijing was high.Age,sex and CVD trends,as well as life style changes,should be considered when prevention and control strategies are formulated.

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function

Objective Both decreased glomemlar filtration rate （GFR） and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. Methods In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR 〉 60 mL/min per 1.73 m2 estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity （PWVcf） and carotid-radial PWV （PWVcr） using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes （AIx-75） was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. Results The mean estimated GFR （eGFR） of the study group was 100.05 ＋ 23.26 mL/minute per 1.73 m2. Subjects were grouped by tertiles of eGFR level. PWVef and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AJx-75. Conclusions In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.

The history, hotspots, and trends of electrocardiogram

The electrocardiogram （ECG） has broad applications in clinical diagnosis and prognosis of cardiovascular disease. Many researchers have contributed to its progressive development. To commemorate those pioneers, and to better study and promote the use of ECG, we reviewed and present here a systematic introduction about the history, hotspots, and trends of ECG. In the historical part, information including the invention, improvement, and extensive applications of ECG, such as in long QT syndrome （LQTS）, angina, and myocardial infarction （MI）, are chronologi- cally presented. New technologies and applications from the 1990s are also introduced. In the second part, we use the bibliometric analysis me- thod to analyze the hotspots in the field of ECG-related research. By using total citations and year-specific total citations as our main criteria, four key hotspots in ECG-related research were identified from 11 articles, including atrial fibrillation, LQTS, angina and MI, and heart rate variability. Recent studies in those four areas are also reported. In the final part, we discuss the future trends concerning ECG-related research. The authors believe that improvement of the ECG instrumentation, big data mining for ECG, and the accuracy of diagnosis and application will be areas of continuous concern.

Prevalence of pulmonary embolism at autopsy among elderly patients in a Chinese general hospital

Objectives To investigate the prevalence and characteristics of pulmonary embolism （PE） at autopsy in a Chinese general hospital over a period of 10 years, and to evaluate the antemortem achievement of the prophylaxis, diagnosis, and treatment of PE. Methods All medical records of deaths from the West Branch of the Chinese People＇s Liberation Army （PLA） General Hospital were retrospectively re- viewed, for the period of January 1, 2006 to December 31, 2015. Cases in which autopsies had been performed were identified and further analyzed. The numbers and detailed characteristics of patients who had PEs were noted. Prophylactic measures, along with diagnosis and treatment of PE, were recorded, if performed. Results During the 10-year period, 1057 patients died in the study hospital and 278 necrop- sies were performed （autopsy rate： 26.3%）. Nine patients were found to have PE （3.2%）, and in seven of these patients （2.5%）, the PE was considered to be fatal. Embolisms were found in the trunk and bilateral main branches of the pulmonary artery tree in all seven of the fatal PE cases. Right intracardiac thrombosis was detected in five of the nine PE patients （55.6%）. All patients with PE had been hospitalized in medical departments, and only one had undergone surgery during hospitalization. Antemortem prophylaxis was performed in two of the nine PE cases （22.2%）. None of the 9 patients had received a clinical diagnosis of PE before death. Conclusions The incidence of and death rate associated with PE may vary among different races and regions. Continuous monitoring of PE by means of necropsy in certain representative medical institutions is necessary.

Plasma homocysteine levels are independently associated with alterations of large artery stiffness in men but not in women

Objectives To investigate the associations of the plasma homocysteine levels with the alterations in arterial stiffness in a commu- nity-based cohort. The gender differences in these associations were examined. Methods We evaluated the relationship between plasma homocysteine levels to three measures of vascular ftmction [carotid-femoral pulse wave velocity （CF-PWV）, carotid-ankle PWV （CA-PWV） and heart rate corrected augmentation index （AI）] in 1680 participants （mean age： 61.5 years; 709 men, 971 women） from communities of Beijing, China. Results In univariate analysis, plasma homocysteine levels was positively related to the CF-PWV （r = 0.211, P 〈 0.0001） and CA-PWV （r = 0.148, P 〈 0.0001）, whereas inversely associated with AI （r = -0.052, P = 0.016）. In multiple linear regression models adjusting for covariants, plasma homocysteine remained positively related to the CF-PWV （standardized 13 = 0.065, P = 0.007） in total cases. When the groups of men and women were examined separately, plasma homocysteine remained positively associated with the CF-PWV （standardized β = 0.082, P = 0.023） in men, whereas the relations between homocysteine and any of the arterial stiffness indices were not further present in women. Conclusions In Chinese population, plasma homocysteine levels are independently associated with alterations of large artery stiffness in men but not in women.

Hydrogen sulfide system in the pathogenesis of renovascular hypertension in rats

Objective To investigate the role of hydrogen sulfide(H_(2)S)synthases/H_(2)S pathway in the pathogenesis of renovascular hypertension.Methods Wistar rats were subdivided into 4 groups:(1)2-kidney,1-clip(2K-1C group,n=7),(2)control(n=7),(3)sham(n=7),and(4)2K-1C plus sodium hydrosulfide(NaHS)(NaHS-treated group,n=7).The systolic blood pressure(SBP)was measured by a tail-cuff method using a pulse transducer once a week.Four weeks later,all rats were killed and the concentration of plasma hydrogen sulfide(H_(2)S),the activity of the H_(2)S synthases in the kidneys on both sides,the plasma angiotensinⅡconcentration,and the left-to-whole heart weight ratio were measured.Results The SBP was significantly increased in the 2K-1C group(185.4±14.0mmHg)comparing with those in the sham group(112.9±6.5mmHg,,or the NaHS-treated group(134.8±9.5mmHg))(both P<0.01).At 4 weeks,the angiotensinⅡconcentration in the plasma was increased in the 2K-1C and NaHS-treated group,comparing with the control and the sham group(306.92±7.03 pg/ml and 240.73±13.22 pg/ml vs 122.6±25.49 pg/ml and 125.95±10.55 pg/ml,respectively,both P<0.05).The plasma H_(2)S concentration and the activity of H_(2)S synthases in the left kidney were decreased in the 2K-1C group comparing with those in the sham and the control groups.There was no difference of the activity of the H_(2)S synthases in the right kidneys among the 4 groups.The left-to-whole heart weight ratio was increased in the 2K-1C and the NaHS-treated group camparing with that in the sham and natural control groups.Conclusions Dysfunction of the H_(2)S synthases/H_(2)S pathway was involved in the 2K-1C-induced renovascular hypertension in rat.Exogenous administration of H_(2)S donor can attenuate the development of hypertension.These findings suggest that the H_(2)S synthases/H_(2)S pathway participates in the pathogenesis of renovascular hypertension.

Profilin-1 is involved in macroangiopathy induced by advanced glycation end products via vascular remodeling and inflammation

BACKGROUND The accumulation of advanced glycation end products(AGEs)have been implicated in the development and progression of diabetic vasculopathy.However,the role of profilin-1 as a multifunctional actin-binding protein in AGEs-induced atherosclerosis(AS)is largely unknown.AIM To explore the potential role of profilin-1 in the pathogenesis of AS induced by AGEs,particularly in relation to the Janus kinase 2(JAK2)and signal transducer and activator of transcription 3(STAT3)signaling pathway.METHODS Eighty-nine individuals undergoing coronary angiography were enrolled in the study.Plasma cytokine levels were detected using ELISA kits.Rat aortic vascular smooth muscle cells(RASMCs)were incubated with different compounds for different times.Cell proliferation was determined by performing the MTT assay and EdU staining.An AGEs-induced vascular remodeling model was established in rats and histological and immunohistochemical analyses were performed.The mRNA and protein levels were detected using real-time PCR and Western blot analysis,respectively.In vivo,shRNA transfection was performed to verify the role of profilin-1 in AGEs-induced proatherogenic mediator release and aortic remodeling.Statistical analyses were performed using SPSS 22.0 software.RESULTS Compared with the control group,plasma levels of profilin-1 and receptor for AGEs(RAGE)were significantly increased in patients with coronary artery disease,especially in those complicated with diabetes mellitus(P<0.01).The levels of profilin-1 were positively correlated with the levels of RAGE(P<0.01);additionally,the levels of both molecules were positively associated with the degree of coronary artery stenosis(P<0.01).In vivo,tail vein injections of AGEs induced the release of proatherogenic mediators,such as asymmetric dimethylarginine,intercellular adhesion molecule-1,and the N-terminus of procollagen III peptide,concomitant with apparent aortic morphological changes and significantly upregulated expression of the profilin-1 mRNA and protein in the thoracic aorta(P<0.05 or P<0.01).Downregulation of profilin-1 expression with an shRNA significantly attenuated AGEs-induced proatherogenic mediator release(P<0.05)and aortic remodeling.In vitro,incubation of vascular smooth muscle cells(VSMCs)with AGEs significantly promoted cell proliferation and upregulated the expression of the profilin-1 mRNA and protein(P<0.05).AGEs(200μg/mL,24 h)significantly upregulated the expression of the STAT3 mRNA and protein and JAK2 protein,which was blocked by a JAK2 inhibitor(T3042-1)and/or STAT3 inhibitor(T6308-1)(P<0.05).In addition,pretreatment with T3042-1 or T6308-1 significantly inhibited AGEs-induced RASMC proliferation(P<0.05).CONCLUSION AGEs induce proatherogenic events such as VSMC proliferation,proatherogenic mediator release,and vascular remodeling,changes that can be attenuated by silencing profilin-1 expression.These results suggest a crucial role for profilin-1 in AGEs-induced vasculopathy.

Effects of febuxostat on atrial remodeling in a rabbit model of atrial fibrillation induced by rapid atrial pacing

Background Febuxostat,a novel nonpurine selective inhibitor of xanthine oxidase(XO),may be used in the prevention and management of atrial fibrillation(AF).The purpose of this study was to evaluate the effects of febuxostat on atrial remodeling in a rabbit model of AF induced by rapid atrial pacing(RAP)and the mechanisms by which it acts.Methods Twenty-four rabbits were randomly divided into four groups:sham-operated group(Group S),RAP group(Group P),RAP with 5 mg/kg per day febuxostat group(Group LFP),and RAP with 10 mg/kg per day febuxostat group(Group HFP).All rabbits except those in Group S were subjected to RAP at 600 beats/min for four weeks.The effects of febuxostat on atrial electrical and structural remodeling,markers of inflammation and oxidative stress,and signaling pathways involved in the left atrium were examined.Results Shortened atrial effective refractory period(AERP),increased AF inducibility,decreased mRNA levels of Cav1.2 and Kv4.3,and left atrial enlargement and dysfunction were observed in Group P,and these changes were suppressed in the groups treated with febuxostat.Prominent atrial fibrosis was observed in Group P,as were increased levels of TGF-β1,Collagen I,andα-SMA and decreased levels of Smad7 and eNOS.Treatment with febuxostat attenuated these differences.Changes in inflammatory and oxidative stress markers induced by RAP were consistent with the protective effects of febuxostat.Conclusions This study is the first to find that febuxostat can inhibit atrial electrical and structural remodeling of AF by suppressing XO and inhibiting the TGF-β1/Smad signaling pathway.

N-terminal pro-brain natriuretic peptide but not high-sensitivity C-reactive protein is related to severity of coronary artery stenosis in patients with acute coronary syndrome

Objective Biochemical indicators such as N-terminal pro-brain type natriuretic peptide（NT pro-BNP）and high-sensitivity Creactive protein（hsCRP）predict mortality in acute coronary syndrome（ACS）.However,little is known about the relationship of these factors with severity of coronary artery stenosis in patients with.Methods Three hundred and thirty-one subjects including 246 unstable angina pectoris patients and 85 myocardial infarction patients were recruited and classified into two groups：single-vessel disease group（1-vessel disease,n=93）and multiple-vessel disease group（≥2-vessels disease,n=238）according to selective coronary angiography.Plasma levels of NT pro-BNP and hsCRP were measured and severity of coronary stenosis was determined by Gensini score.Results NT pro-BNP but not hsCRP level was higher in patients with myocardial infarction than in patients with unstable angina pectoris.The patients with multiple-vessel disease had significantly higher NT pro-BNP level but not hsCRP compared with those with single-vessel disease.NT pro-BNP levels increased significantly as left ventricle（LV）function decreased,and only NT proBNP but not hsCRP level was related to Gensini score of severity of coronary stenosis in ACS.Conclusion NT proBNP but not hsCRP level is related to severity of coronary artery stenosis in patients in ACS.

Relationship of level of sex hormone and sex hormone receptor with development of metabolic syndrome in elderly men

Objective The sex hormone and the corresponding receptor may play some roles in the development of the metabolic syndrome （MS） in the elderly men. This study was designed to examine the relationship of level of the sex hormone and androgen receptor with MS in elderly men, thus to investigate the possible pathogenesis of MS. Methods This cross sectional study enrolled 587 elderly men, including 400 healthy controlls aged 62-92 years and 187 MS patients aged 60-87 years in Wan Shou Lu area of Beijing city. Dehydroepiandrosterone sulfate （DHAE-S）, total testosterone （TT）, sex hormone binding globulin （SHBG）, free testosterone （FT）, follicle-stimulating hormone （FSH）,Estradiol （E2）,luteinizing hormone（LH） and androgen receptor （AR） in blood were tested. Statistical analyses included the comparison analysis of variables and independent variables, correlation analysis using multi-factor linear regression, and multiple logistic regression analysis. Results DHAE-S, TT, SHBG, FT and AR fluorescence intensity in healthy control group were higher than those in MS group, however, FSH and E2 levels were lower in healthy group. Age was negatively correlated with diastolic blood pressure （DBP） and FT, but positively correlated with systolic blood pressure （SBP） and E2. AR fluorescence intensity was negatively correlated with SBP and LH. The logistic regression equation showed the negative correlation between DHEA-S, SHBG and the development of MS. Conclusions There are low levels of DHEA-S, TT, SHBG, FT and AR in the elderly patients with MS. On the contrary, FSH and E2 concentration are higher. It can be suggested that low levels of DHEA-S and SHBG may be the potential risk factors of MS in elderly men.

Prediction of acute stroke progression by the National Institutes of Health Stroke Scale

Objective To determine the occurrence of neurological changes during the first 48 hours after acute stroke as it relates to the initial stroke severity assessment. Methods The assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed serially for the first 48 hours on 68 consecutive ischemic stroke patients admitted to the Department of Geriatric Cardiology at the Khanh Hoa Hospital, Nha Trang, Vietnam. Incidence of stroke progression (a ≥ 3-point increase on the NIHSS) was recorded and analysis performed to determine its association with initial stroke severity and other demographic and physiological variables. Deficit resolution by 48 hours, defined as an NIHSS score of 0 or 1, measured the frequency of functional recovery predicted by the initial deficit. Results Overall progression was noted in 28% of events (19/68). Applying Bayes' solution to the observed frequency of worsening, the greatest likelihood of predicting future patient progression occurred with NIHSS score of =7 and >7. Patients with an initial NIHSS score of =7 experienced a 13% (6/47) worsening rate versus those of an initial score of >7 with a 62% (13/21) worsening rate (P<0.01). 42.5% (20/47) of those with an initial score of =7 were functionally normal at 48 hours, whereas only 4.7% (1/21) of those with scores of >7 returned to a normal examination within this period (χ2, P<0.05). Conclusions This study suggests that the early clinical course of neurological deficit after acute stroke be dependent on the initial stroke severity and that a dichotomy in early outcome exist surrounding an initial NIHSS score of 7. These findings may have significant implications for the design and patient stratification in treatment protocols with respect to primary clinical outcome.(J Geriatr Cardiol 2007;4:225-228.)

Efficacy of Yiqi Fumai (Freeze-Dried Powder) on Ischemic Diastolic Heart Failure

Objective: To evaluate the efficacy of Yiqi Fumai freeze-dry powder (YFP) on ischemic diastolic heart failure. Methods: 100 patients diagnosed with unstable angina accompanying ischemic diastolic heart failure (IDHF) were selected randomly. 52 patients with TCM syndrome of qi-yin deficiency were divided into Chinese and Western combination therapy group. 48 patients have no TCM syndrome of qi-yin deficiency, and were treated with standard western medicine. After treatment, Seattle Angina Questionnaire Evaluation, ECG, conventional and stress echocardiography (SE) index, NT-proBNP were compared between before and after treatment. Results: The differences of PL, TS, DP between before and after treatment by YFP were statistically significant

GRK 2 level in peripheral blood lymphocytes of elderly patients with acute myocardial infarction

Objective To investigate the G protein-coupled receptor kinase 2 (GRK 2) level in peripheral blood lymphocytes with cardiac func-tion in elderly patients with acute myocardial infarction. Methods This study enrolled 40 patients with acute ST-segment elevation myo-cardial infarction (STEMI) and 40 patients with unstable angina. All patients were 65 years or older. Cardiac function was evaluated by echocardiography, and the GRK 2 level in peripheral blood lymphocytes was measured. Patients with STEMI were followed up for 2 years. Results The GRK 2 level in peripheral blood lymphocytes was significantly higher in patients with STEMI than in patients with unstable angina, and was negatively correlated with left ventricular ejection fraction, cardiac output, stroke volume, and left ventricular fractional shortening. The GRK 2 level was significantly elevated in some patients with acute STEMI and poor cardiac function. Conclusions In-creased GRK 2 level in patients with acute STEMI may contribute to poor myocardial systolic function and myocardial remodeling. Meas-urement of the GRK 2 level in peripheral blood lymphocytes may assist in the evaluation of cardiac function and myocardial remodeling in elderly patients with acute STEMI.

Chronic kidney disease: an independent risk factor of all-cause mortality for elderly Chinese patients with chronic heart failure

Objective To evaluate the prognostic value of chronic kidney disease (CKD) in elderly Chinese patients with chronic heart failure (CHF). Methods The study consisted of 327 elderly patients with CHF. All-cause mortality was chosen as an endpoint over the median follow-up period of 345 days. Cox regression analysis was used to identify the risk factors of mortality. Results The median age of the entire cohort was 85 years (60��100 years). The mortality for 168 elderly patients with CHF and CKD (51.4% of entire cohort) was 39.9% (67 deaths), which was higher than the mortality for CHF patientswithout CKD [25.2% (40/159 deaths)] and the mortality for entire cohort with CHF [32.7% (107/327 deaths)]. The Cox regression analysis showed that old age [hazard ratio (HR): 1.033; 95% confidence interval (95%CI): 1.004��1.064], CKD(HR: 1.705; 95%CI: 1.132��2.567), CHF New York HeartAssociation (NYHA) class IV (HR: 1.913; 95% CI: 1.284��2.851), acute myocardial infarction (AMI) (HR: 1.696; 95% CI: 1.036��2.777), elevated resting heart rate (HR: 1.021; 95% CI: 1.009��1.033), and decreased plasma albumin (HR: 0.883; 95% CI: 0.843��0.925) were independent risk factors of mortality for elderly patientswith CHF. Conclusions CKDwas an independent risk factor of mortality for elderly Chinese patientswith CHF.

Effect of Atorvastatin on Expression of Peroxisome Proliferator-activated Receptor Beta/delta in Angiotensin Ⅱ-induced Hypertrophic Myocardial Cells In Vitro

Objective To explore the effect of atorvastatin on cardiac hypertrophy and to determine the potential mechanism involved. Methods An in vitro cardiomyocyte hypertrophy from neonatal rats was induced with angiotensinⅡ(Ang Ⅱ) stimulation. Before AngⅡ stimulation, the cultured rat cardiac myocytes were pretreated with atorvastatin at different concentrations(0.1, 1, and 10 μmol/L). The following parameters were evaluated: the myocyte surface area, 3H-leucine incorporation into myocytes, m RNA expressions of atrial natriuretic peptide, brain natriuretic peptide, matrix metalloproteinase 9, matrix metalloproteinase 2, and interleukin-1β, m RNA and protein expressions of the δ/β peroxisome proliferator-activated receptor(PPAR) subtypes. Results It was shown that atorvastatin could ameliorate Ang Ⅱ-induced neonatal cardiomyocyte hypertrophy in the area of cardiomyocytes, 3H-leucine incorporation, and the expression of atrial natriuretic peptide and brain natriuretic peptide markedly. Meanwhile, atorvastatin also inhibited the augmented m RNA level of several cytokines in hypertrophic myocytes. Furthermore, the down-regulated expression of PPAR-δ/β at both the m RNA and protein levels in hypertrophic myocytes could be significantly reversed by atorvastatin treatment. Conclusions Atorvastatin could improve AngⅡ-induced cardiac hypertrophy and inhibit the expression of cytokines. Such effect might be partly achieved through activation of the PPAR-δ/β pathway.

Clinical characteristics, target organ damage and associate risk factors ofresistant hypertension determined by ambulatory blood pressure monitoringin patients aged ≥80 years

Objectives To investigate clinical characteristics, target organ damage, and the associated risk factors of the patients aged ≥ 80 yearswith true resistant hypertension （RH）. Methods Patients aged ≥ 80 years with hypertension （n = 1163） were included in this study. Theincluded participants attended a structured clinical examination and an evaluation of RH was carried out. The prevalence, clinical characteristicsand target organ damage of patients with RH were assessed. The associated clinical risk factors were analyzed by using logistic regression.Results The prevalence of RH diagnosis by 24-h ambulatory blood pressure monitoring assessment was 21.15%. End-diastolic left ven-tricular internal dimension, left ventricular mass index as well as prevalence of left ventricular hypertrophy were significantly greater in pa-tients with RH than in control group. The common carotid artery intimal media thickness, carotid walls thickness, common carotid arterydiameter and relative wall thickness were significant greater in RH group than in control. A relatively higher level of creatinine, estimatedglomerular filtration rate, microalbuminuria and retinal changes was found in RIt group than in control. A multivariate analysis showed thatpatients with a history of diabetes, higher body mass index （BMI） and lipid profiles were independent risk factors of RH. Conclusions Theprevalence of RH in patients aged ≥ 80 years was within the range of reported rates of the general population. Subjects with RH diagnosisshowed a higher occurrence of target organ damage than patients with well controlled blood pressure. Patients with diabetes, higher BMI andserum lipid profiles were independent risk factors for RH in patients aged ≥ 80 years.

Cancer risk in older people receiving statin therapy： a meta-analysis of randomized controlled trials

Background Although statins are well tolerated by most aged people, their potential carcinogenicity is considered as one of the big-gest factors limiting the use of statins. The aim of the present study was to determine the risk of cancer in people aged over 60 years receiving statin therapy. Methods A comprehensive search for articles published up to December 2015 was performed, reviews of each randomized controlled trials （RCTs） that compared the effects of statin mono-therapy with placebo on the risk of cancer in people aged 〉 60 years were conducted and data abstracted. All the included studies were evaluated for publication bias and heterogeneity. Pooled odds ratios （OR） estimates and 95% confidence intervals （CIs） were calculated using the random effects model. Results A total of 12 RCTs, involving 62,927 patients （31,517 in statin therapy group and 31,410 in control group）, with a follow-up duration of 1.9-5.4 years, contributed to the analysis. The statin therapy did not affect the overall incidence of cancer （OR = 1.03, 95% CI： 0.94-1.14, P = 0.52）; subgroup analyses showed that neither the variety nor the chemical properties of the statins accounted for the incidence of cancer in older people. Conclusions Our meta- analysis findings do not support a potential cancer risk of statin treatment in people over 60 years old. Further targeted researches with a longer follow-up duration are warranted to confirm this issue.