BACKGROUND His bundle pacing(HBP)and left bundle branch pacing(LBBP)both provide physiologic pacing which maintain left ventricular synchrony.They both improve heart failure(HF)symptoms in atrial fibrillation(AF)patie...BACKGROUND His bundle pacing(HBP)and left bundle branch pacing(LBBP)both provide physiologic pacing which maintain left ventricular synchrony.They both improve heart failure(HF)symptoms in atrial fibrillation(AF)patients.We aimed to assess the intra-patient comparison of ventricular function and remodeling as well as leads parameters corresponding to two pacing modalities in AF patients referred for pacing in intermediate term.METHODS Uncontrolled tachycardia AF patients with both leads implantation successfully were randomized to either modality.Echocardiographic measurements,New York Heart Association(NYHA)classification,quality-of-life assessments and leads parameters were obtained at baseline and at each 6-month follow up.Left ventricular function including the left ventricular endosystolic volume(LVESV),left ventricular ejection fraction(LVEF)and right ventricular(RV)function quantified by tricuspid annular plane systolic excursion(TAPSE)were all assessed.RESULTS Consecutively twenty-eight patients implanted with both HBP and LBBP leads successfully were enrolled(69.1±8.1 years,53.6% male,LVEF 59.2%±13.7%).The LVESV was improved by both pacing modalities in all patients(n=23)and the LVEF was improved in patients with baseline LVEF at less than 50%(n=6).The TAPSE was improved by HBP but not LBBP(n=23).CONCLUSION In this crossover comparison between HBP and LBBP,LBBP was found to have an equivalent effect on LV function and remodeling but better and more stable parameters in AF patients with uncontrolled ventricular rates referred for atrioventricular node(AVN)ablation.HBP could be preferred in patients with reduced TAPSE at baseline rather than LBBP.展开更多
OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and...OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.展开更多
Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibro...Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.展开更多
Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selecti...Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups. Results The Gensini score was significantly higher in the blood group A than in the non-A groups(41.2 ± 32 vs. 38 ± 27;P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD(β= 3.298, 95% CI: 0.91–6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score(P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension. Conclusion In this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes.展开更多
BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary interven...BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording to the TIMI frame count were assessed using multivariate linear regression.RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris.By multivariate logistic regression, the following characteristics were statistically identified as riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate linear regression, the statistical risk factors for TIMI frame count included: female sex,older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.展开更多
BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgentl...BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.展开更多
Background:Resting heart rate(RHR)is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients.Bisoprolol fumarate,a second-generation beta-adrenoreceptor bl...Background:Resting heart rate(RHR)is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients.Bisoprolol fumarate,a second-generation beta-adrenoreceptor blockers(β-blocker)is commonly prescribed drug to manage hypertension.The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease(CAD)patients from the CAD treated with bisoprolol(BISO-CAD)study who had comorbid hypertension.Methods::We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study(n=866),which was a phase IV,multination,multi-center,single-arm,observational study carried out from October 2011 to July 2015 across China,South Korea,and Vietnam.Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome(CCCO),the results were presented as adjusted odds ratio(OR)along with 95%confidence interval(CI)and adjusted P value.Results::A total of 681 patients(mean age:64.77±10.33 years)with hypertension from BISO-CAD study were included in the analysis.Bisoprolol improved CCCOs in CAD patients with comorbid hypertension,with RHR<65 and<70 beats/min compared with RHR≥65 and≥75 beats/min,respectively,in the efficacy analysis(EA)set.In addition,it lowered RHR in both intent-to-treat(ITT)and EA groups after 6,12,and 18 months of treatment.Further,RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients(adjusted OR:4.34;95%CI:1.19-15.89;P=0.03).Also,events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR<69 beats/min in ITT patients.Conclusion::Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence,improve CCCO without affecting their blood pressure.展开更多
Background: Patients with diabetes mellitus (DM) have a higher risk of thromboembolic events: however, the optimal duration of dual antiplatelet therapy (DAPT) remains unclear. The goal of this study was to asse...Background: Patients with diabetes mellitus (DM) have a higher risk of thromboembolic events: however, the optimal duration of dual antiplatelet therapy (DAPT) remains unclear. The goal of this study was to assess the efficacy and safety of various DAPT durations in patients with DM undergoing drug-eluting stent implantation. Methods: We conducted a literature search for randomized controlled trials (RCTs). We searched databases including EMBASE, PubMed, Cochrane Library, and Scopus up to June 2016. Investigators extracted data independently, including outcomes, characteristics, and study quality. A random-effect model was used to pool odds ratios (ORs) with 95% confidence intervals (C/s) of the clinical outcomes. Results: Six RCTs totaling 6040 patients with DM were included in the study. Shorter-duration DAPT resulted in an increased rate of stent thrombosis (ST) (OR, 1.83, 95% CI: 1.03-3.26, P = 0.04), but did not increase the risk of myocardial inihrction (OR. 1.33, 95% CI: 0.71 2.47, P=0.37), stroke (OR, 0.96, 95% CI: 0.52-1.77, P 0.90), target vessel revascularization (OR, 1.19, 95% CI: 0.46-3.07, P = 0.71 ), all-cause death (OR: 0.72, 95% CI: 0.48-1.09, P = 0.12), or cardiac death (OR, 0.82, 95% CI: 0.49-1.36, P= 0.44) significantly. Shorter-duration DAPT was associated with a decreased risk of major bleeding (OR. 0.60, 95% CI: 0.38-0.94, P = 0.02). Conclusion: In patients with DM, longer-duration DAPT had a lower risk of ST, but was associated with an increased bleeding risk.展开更多
Stiffening of blood vessels is one of the most important characteristics in the process of many cardiovascular pathologies such as atherosclerosis,angiosteosis,and vascular aging.Increased stiffness of the vascular ex...Stiffening of blood vessels is one of the most important characteristics in the process of many cardiovascular pathologies such as atherosclerosis,angiosteosis,and vascular aging.Increased stiffness of the vascular extracellular matrix drives artery pathology and alters phenotypes of vascular cell.Understanding how substrate stiffness impacts vascular cell behaviors is of great importance to the biomaterial design in tissue engineering,regenerative medicine,and medical devices.Here we report that changing substrate stiffness has a significant impact on the autophagy of vascular endothelial cells(VECs)and smooth muscle cells(VSMCs).Interestingly,our findings demonstrate that,with the increase of substrate stiffness,the autophagy level of VECs and VSMCs showed differential changes:endothelial autophagy levels reduced,leading to the reductions in a range of gene expression associated with endothelial function;while,autophagy levels of VSMCs increased,showing a transition from contractile to the synthetic phenotype.We further demonstrate that,by inhibiting cell autophagy,the expressions of endothelial functional gene were further reduced and the expression of VSMC calponin increased,suggesting an important role of autophagy in response of the cells to the challenge of microenvironment stiffness changing.Although the underlying mechanism requires further study,this work highlights the relationship of substrate stiffness,autophagy,and vascular cell behaviors,and enlightening the design principles of surface stiffness of biomaterials in cardiovascular practical applications.展开更多
With accumulating evidence of transcatheter aortic valve replacement(TAVR)worldwide,it is gradually realized that patients being treated are different across different coun-tries,including but not limited to their age...With accumulating evidence of transcatheter aortic valve replacement(TAVR)worldwide,it is gradually realized that patients being treated are different across different coun-tries,including but not limited to their age,habitus,disease etiology,aortic valve morphology,and sizes of structures.[1]In China,the average age of TAVR patients is around 5 years younger than industrialized countries,[2]making Chinese patients a good predictive sample of what the industrialized countries might see in TAVR screening in the near future due to the expansion of this technique to younger patients,but anatomical features appreciated from multi-slice computed tomography(MSCT)in the Chinese patient population have not been well demonstrated.展开更多
The in-stent restenosis(IRS)after the percutaneous coronary intervention contributes to the major treatment failure of stent implantation.MicroRNAs have been revealed as powerful gene medicine to regulate endothelial ...The in-stent restenosis(IRS)after the percutaneous coronary intervention contributes to the major treatment failure of stent implantation.MicroRNAs have been revealed as powerful gene medicine to regulate endothelial cells(EC)and smooth muscle cells(SMC)in response to vascular injury,providing a promising therapeutic candidate to inhibit IRS.However,the controllable loading and eluting of hydrophilic bioactive microRNAs pose a challenge to current lipophilic stent coatings.Here,we developed a microRNA eluting cardiovascular stent via the self-healing encapsulation process based on an amphipathic poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone)(PCL-PEG-PCL,PCEC)triblock copolymer spongy network.The miR-22 was used as a model microRNA to regulate SMC.The dynamic porous coating realized the uniform and controllable loading of miR-22,reaching the highest dosage of 133 pmol cm^(-2).We demonstrated that the sustained release of miR-22 dramatically enhanced the contractile phenotype of SMC without interfering with the proliferation of EC,thus leading to the EC dominating growth at an EC/SMC ratio of 5.4.More importantly,the PCEC@miR-22 coated stents showed reduced inflammation,low switching of SMC phenotype,and low secretion of extracellular matrix,which significantly inhibited IRS.This work provides a simple and robust coating platform for the delivery of microRNAs on cardiovascular stent,which may extend to other combination medical devices,and facilitate practical application of bioactive agents in clinics.展开更多
To the Editor:A 70-year-old male patient underwent transcatheter aortic valve implantation(TAVI)for severe aortic stenosis.Echocardiography showed that the peak velocity in aortic valve was 4.33 m/s,with a peak pressu...To the Editor:A 70-year-old male patient underwent transcatheter aortic valve implantation(TAVI)for severe aortic stenosis.Echocardiography showed that the peak velocity in aortic valve was 4.33 m/s,with a peak pressure gradient of 75 mmHg and a mean pressure gradient of 38 mmHg.The end-systolic dimension and end-diastolic dimension of left ventricle was 31.7 and 50.0 mm,respectively.展开更多
基金supported by Medical Science and Technology Project of Zhejiang Province(Grant Number 2020KY220 and 2022506537)the funding from Clinical research project of Zhejiang Medical Association(No.2016ZYC-A28).
文摘BACKGROUND His bundle pacing(HBP)and left bundle branch pacing(LBBP)both provide physiologic pacing which maintain left ventricular synchrony.They both improve heart failure(HF)symptoms in atrial fibrillation(AF)patients.We aimed to assess the intra-patient comparison of ventricular function and remodeling as well as leads parameters corresponding to two pacing modalities in AF patients referred for pacing in intermediate term.METHODS Uncontrolled tachycardia AF patients with both leads implantation successfully were randomized to either modality.Echocardiographic measurements,New York Heart Association(NYHA)classification,quality-of-life assessments and leads parameters were obtained at baseline and at each 6-month follow up.Left ventricular function including the left ventricular endosystolic volume(LVESV),left ventricular ejection fraction(LVEF)and right ventricular(RV)function quantified by tricuspid annular plane systolic excursion(TAPSE)were all assessed.RESULTS Consecutively twenty-eight patients implanted with both HBP and LBBP leads successfully were enrolled(69.1±8.1 years,53.6% male,LVEF 59.2%±13.7%).The LVESV was improved by both pacing modalities in all patients(n=23)and the LVEF was improved in patients with baseline LVEF at less than 50%(n=6).The TAPSE was improved by HBP but not LBBP(n=23).CONCLUSION In this crossover comparison between HBP and LBBP,LBBP was found to have an equivalent effect on LV function and remodeling but better and more stable parameters in AF patients with uncontrolled ventricular rates referred for atrioventricular node(AVN)ablation.HBP could be preferred in patients with reduced TAPSE at baseline rather than LBBP.
基金supported by the National Key Research and Development Program of China(2016YFC1300300)。
文摘OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.
基金supported by Zhejiang Natural Science Foundation (LY18H020007 and LQ16H020001)National Natural Science Foundation of China (81500212 and 81800212)。
文摘Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.
基金supported by grants from Clinical Vascular Grant in Chinese Physicians—VG
文摘Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups. Results The Gensini score was significantly higher in the blood group A than in the non-A groups(41.2 ± 32 vs. 38 ± 27;P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD(β= 3.298, 95% CI: 0.91–6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score(P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension. Conclusion In this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes.
基金supported by Zhejiang Natural ScienceFoundation (LY18H020007).
文摘BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording to the TIMI frame count were assessed using multivariate linear regression.RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris.By multivariate logistic regression, the following characteristics were statistically identified as riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate linear regression, the statistical risk factors for TIMI frame count included: female sex,older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.
文摘BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.
基金supported by Zhejiang Provincial Natural Science Foundation of China (LD22E030008)National Natural Science Foundation of China (U20A20262)+2 种基金the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2022483477)the Fundamental Research Funds for the Central Universities (226-2023-00074)supported by Zhejiang University K. P. Chao’s High Technology Development Foundation
基金This study was funded by Merck Serono Co.,Ltd,an affiliate of Merck KGaA,Darmstadt,Germany.
文摘Background:Resting heart rate(RHR)is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients.Bisoprolol fumarate,a second-generation beta-adrenoreceptor blockers(β-blocker)is commonly prescribed drug to manage hypertension.The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease(CAD)patients from the CAD treated with bisoprolol(BISO-CAD)study who had comorbid hypertension.Methods::We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study(n=866),which was a phase IV,multination,multi-center,single-arm,observational study carried out from October 2011 to July 2015 across China,South Korea,and Vietnam.Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome(CCCO),the results were presented as adjusted odds ratio(OR)along with 95%confidence interval(CI)and adjusted P value.Results::A total of 681 patients(mean age:64.77±10.33 years)with hypertension from BISO-CAD study were included in the analysis.Bisoprolol improved CCCOs in CAD patients with comorbid hypertension,with RHR<65 and<70 beats/min compared with RHR≥65 and≥75 beats/min,respectively,in the efficacy analysis(EA)set.In addition,it lowered RHR in both intent-to-treat(ITT)and EA groups after 6,12,and 18 months of treatment.Further,RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients(adjusted OR:4.34;95%CI:1.19-15.89;P=0.03).Also,events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR<69 beats/min in ITT patients.Conclusion::Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence,improve CCCO without affecting their blood pressure.
文摘Background: Patients with diabetes mellitus (DM) have a higher risk of thromboembolic events: however, the optimal duration of dual antiplatelet therapy (DAPT) remains unclear. The goal of this study was to assess the efficacy and safety of various DAPT durations in patients with DM undergoing drug-eluting stent implantation. Methods: We conducted a literature search for randomized controlled trials (RCTs). We searched databases including EMBASE, PubMed, Cochrane Library, and Scopus up to June 2016. Investigators extracted data independently, including outcomes, characteristics, and study quality. A random-effect model was used to pool odds ratios (ORs) with 95% confidence intervals (C/s) of the clinical outcomes. Results: Six RCTs totaling 6040 patients with DM were included in the study. Shorter-duration DAPT resulted in an increased rate of stent thrombosis (ST) (OR, 1.83, 95% CI: 1.03-3.26, P = 0.04), but did not increase the risk of myocardial inihrction (OR. 1.33, 95% CI: 0.71 2.47, P=0.37), stroke (OR, 0.96, 95% CI: 0.52-1.77, P 0.90), target vessel revascularization (OR, 1.19, 95% CI: 0.46-3.07, P = 0.71 ), all-cause death (OR: 0.72, 95% CI: 0.48-1.09, P = 0.12), or cardiac death (OR, 0.82, 95% CI: 0.49-1.36, P= 0.44) significantly. Shorter-duration DAPT was associated with a decreased risk of major bleeding (OR. 0.60, 95% CI: 0.38-0.94, P = 0.02). Conclusion: In patients with DM, longer-duration DAPT had a lower risk of ST, but was associated with an increased bleeding risk.
基金supported by the National Natural Science Foundation of China(21875210)the National Key Research and Development Program of China(2016YFC1102203)+3 种基金the Natural Key Research and Development Project of Zhejiang Province(2018C03015)Zhejiang Provincial Ten Thousand Talents Program(2018R52001)the Fundamental Research Funds for the Central Universities(2020FZZX003-01-03)the Higher Education Discipline Innovation Project(111 Project)under Grant No.B16042.
文摘Stiffening of blood vessels is one of the most important characteristics in the process of many cardiovascular pathologies such as atherosclerosis,angiosteosis,and vascular aging.Increased stiffness of the vascular extracellular matrix drives artery pathology and alters phenotypes of vascular cell.Understanding how substrate stiffness impacts vascular cell behaviors is of great importance to the biomaterial design in tissue engineering,regenerative medicine,and medical devices.Here we report that changing substrate stiffness has a significant impact on the autophagy of vascular endothelial cells(VECs)and smooth muscle cells(VSMCs).Interestingly,our findings demonstrate that,with the increase of substrate stiffness,the autophagy level of VECs and VSMCs showed differential changes:endothelial autophagy levels reduced,leading to the reductions in a range of gene expression associated with endothelial function;while,autophagy levels of VSMCs increased,showing a transition from contractile to the synthetic phenotype.We further demonstrate that,by inhibiting cell autophagy,the expressions of endothelial functional gene were further reduced and the expression of VSMC calponin increased,suggesting an important role of autophagy in response of the cells to the challenge of microenvironment stiffness changing.Although the underlying mechanism requires further study,this work highlights the relationship of substrate stiffness,autophagy,and vascular cell behaviors,and enlightening the design principles of surface stiffness of biomaterials in cardiovascular practical applications.
基金the National Natural Science Foundation of China(No.81970325 and No.82102129)Open Fund Research from State Key Laboratory of Hydraulics and Mountain River Engineering(No.SKHL1920).
文摘With accumulating evidence of transcatheter aortic valve replacement(TAVR)worldwide,it is gradually realized that patients being treated are different across different coun-tries,including but not limited to their age,habitus,disease etiology,aortic valve morphology,and sizes of structures.[1]In China,the average age of TAVR patients is around 5 years younger than industrialized countries,[2]making Chinese patients a good predictive sample of what the industrialized countries might see in TAVR screening in the near future due to the expansion of this technique to younger patients,but anatomical features appreciated from multi-slice computed tomography(MSCT)in the Chinese patient population have not been well demonstrated.
基金This research was supported by the National Key Research and Development Program of China(2016YFC1102203)the National Natural Science Foundation of China(51933009,21875210)+3 种基金the Natural Key Research and Development Project of Zhejiang Province(2018C03015)Zhejiang Provincial Ten Thousand Talents Program(2018R52001)the Fundamental Research Funds for the Central Universities(2020FZZX003-01-03)the Higher Education Discipline Innovation Project(111 Project)under Grant No.B16042.
文摘The in-stent restenosis(IRS)after the percutaneous coronary intervention contributes to the major treatment failure of stent implantation.MicroRNAs have been revealed as powerful gene medicine to regulate endothelial cells(EC)and smooth muscle cells(SMC)in response to vascular injury,providing a promising therapeutic candidate to inhibit IRS.However,the controllable loading and eluting of hydrophilic bioactive microRNAs pose a challenge to current lipophilic stent coatings.Here,we developed a microRNA eluting cardiovascular stent via the self-healing encapsulation process based on an amphipathic poly(ε-caprolactone)-poly(ethylene glycol)-poly(ε-caprolactone)(PCL-PEG-PCL,PCEC)triblock copolymer spongy network.The miR-22 was used as a model microRNA to regulate SMC.The dynamic porous coating realized the uniform and controllable loading of miR-22,reaching the highest dosage of 133 pmol cm^(-2).We demonstrated that the sustained release of miR-22 dramatically enhanced the contractile phenotype of SMC without interfering with the proliferation of EC,thus leading to the EC dominating growth at an EC/SMC ratio of 5.4.More importantly,the PCEC@miR-22 coated stents showed reduced inflammation,low switching of SMC phenotype,and low secretion of extracellular matrix,which significantly inhibited IRS.This work provides a simple and robust coating platform for the delivery of microRNAs on cardiovascular stent,which may extend to other combination medical devices,and facilitate practical application of bioactive agents in clinics.
文摘To the Editor:A 70-year-old male patient underwent transcatheter aortic valve implantation(TAVI)for severe aortic stenosis.Echocardiography showed that the peak velocity in aortic valve was 4.33 m/s,with a peak pressure gradient of 75 mmHg and a mean pressure gradient of 38 mmHg.The end-systolic dimension and end-diastolic dimension of left ventricle was 31.7 and 50.0 mm,respectively.