Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(...Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.展开更多
The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not re...The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not respond well to pharmaceutical treatment for various reasons.Iatrogenic atrioventricular(AV)node ablation needs to be performed under these extreme conditions to lower the patient’s heart rate.展开更多
Objectives To evaluate the association of coronary artery endothelial function and plasma levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in patients with Type 2 ...Objectives To evaluate the association of coronary artery endothelial function and plasma levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in patients with Type 2 Diabetes Mellitus (DM). Methods We investigated 90 participants from our institution between October 2007 to March 2010: non-DM(n = 60) and DM(n = 30). As an indicator of coronary endothelial dysfunction, we used non-invasive Doppler echocardiography to quantify coronary flow velocity reserve (CFVR) in the distal part of the left descending artery after rest and after intravenous adenosine administration. Results Plasma level of LDL-C was significantly higher in patients with DM than in non-DM (3.21 ±0.64 vs. 2.86 ±0.72 mmo/L, P < 0.05), but HDL-C level did not differ between the groups (1.01 ±0.17 vs. 1.05 ±0.19 mmo/L). Furthermore, the CFVR value was lower inDMpatients than non-diabetics (2.45 ±0.62 vs. 2.98 ±0.68, P < 0.001). Plasma levels of LDL-C were negatively correlated with CFVR in all subjects (r = ��0.35, P < 0.001; 95% confidence interval (CI): ��0.52 –��0.15) and in the non-DM(r = ��0.29, P < 0.05; 95% CI: ��0.51–��0.05), with an even stronger negative correlation in the DM group (r = ��0.42, P < 0.05; 95%CI: ��0.68 –��0.06). Age (β= ��0.019, s = 0.007, sβ= ��0.435, 95% CI: ��0.033 –��0.005, P = 0.008), LDL-C (β= ��0.217, s = 0.105, sβ= ��0.282, 95% CI: ��0.428 –��0.005, P = 0.045) remained independently correlated with CFVR in the DM group. However, we found no correlation between HDL-C level and CFVR in any group. Conclusions Diabetes may contribute to coronary artery disease (CAD) by inducing dysfunction of the coronary artery endothelium. Increased LDL-C level may adversely impair coronary endothelial function in DM. HDL-C may lose its endothelial-protective effects, in part as a result of pathological conditions, especially under abnormal glucose metabolism.展开更多
Acute obstruction of the right coronary ar-tery(RCA)can lead to right ventricular myocardial infarction(MI),which rarely lead to cardiogenic shock(CS).Hemodynamic sta-bility could be restored through fluid resuscitati...Acute obstruction of the right coronary ar-tery(RCA)can lead to right ventricular myocardial infarction(MI),which rarely lead to cardiogenic shock(CS).Hemodynamic sta-bility could be restored through fluid resuscitation and vasoactive drugs in most circumstances.Here,we present a highly representative case of refractory CS caused by massive right ventricular MI with api-cal aneurysm formation,who was successfully treated with extracorporeal membrane oxygenation(ECMO)post severe complication of acute right coronal dis-section.展开更多
To the Editor:The coagulation system is a complex regulatory system in the human body.In this case,the young patient had various vital thrombosis,including cerebral venous sinus thrombosis(CVST),coronary thrombosis,an...To the Editor:The coagulation system is a complex regulatory system in the human body.In this case,the young patient had various vital thrombosis,including cerebral venous sinus thrombosis(CVST),coronary thrombosis,and left ventricular thrombus.However,the patient had neither hypercoagulable-related diseases nor risks nor coagulative or fibrinolytic protein deficiency.[1] Further genetic testing did not show the usual gene mutations relevant to coagulation dysfunction.W e report such a patient with a slight elevation in coagulation FVIII activity and a rare FVIII gene duplication.展开更多
基金supported by the National Natural Science Foundation of China(81400262)the Backbone Fund of Peking University Third Hospital(Y72497-04)
文摘Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.
基金This study was supported by the National Natural Science Foundation of China(No.31700674).
文摘The core treatment of rapid arrhythmiainduced heart failure(HF)is to control the ventricular rate to an optimized lower level,which is usually achieved with various anti-arrhythmic drugs.However,arrhythmias may not respond well to pharmaceutical treatment for various reasons.Iatrogenic atrioventricular(AV)node ablation needs to be performed under these extreme conditions to lower the patient’s heart rate.
文摘Objectives To evaluate the association of coronary artery endothelial function and plasma levels of low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in patients with Type 2 Diabetes Mellitus (DM). Methods We investigated 90 participants from our institution between October 2007 to March 2010: non-DM(n = 60) and DM(n = 30). As an indicator of coronary endothelial dysfunction, we used non-invasive Doppler echocardiography to quantify coronary flow velocity reserve (CFVR) in the distal part of the left descending artery after rest and after intravenous adenosine administration. Results Plasma level of LDL-C was significantly higher in patients with DM than in non-DM (3.21 ±0.64 vs. 2.86 ±0.72 mmo/L, P < 0.05), but HDL-C level did not differ between the groups (1.01 ±0.17 vs. 1.05 ±0.19 mmo/L). Furthermore, the CFVR value was lower inDMpatients than non-diabetics (2.45 ±0.62 vs. 2.98 ±0.68, P < 0.001). Plasma levels of LDL-C were negatively correlated with CFVR in all subjects (r = ��0.35, P < 0.001; 95% confidence interval (CI): ��0.52 –��0.15) and in the non-DM(r = ��0.29, P < 0.05; 95% CI: ��0.51–��0.05), with an even stronger negative correlation in the DM group (r = ��0.42, P < 0.05; 95%CI: ��0.68 –��0.06). Age (β= ��0.019, s = 0.007, sβ= ��0.435, 95% CI: ��0.033 –��0.005, P = 0.008), LDL-C (β= ��0.217, s = 0.105, sβ= ��0.282, 95% CI: ��0.428 –��0.005, P = 0.045) remained independently correlated with CFVR in the DM group. However, we found no correlation between HDL-C level and CFVR in any group. Conclusions Diabetes may contribute to coronary artery disease (CAD) by inducing dysfunction of the coronary artery endothelium. Increased LDL-C level may adversely impair coronary endothelial function in DM. HDL-C may lose its endothelial-protective effects, in part as a result of pathological conditions, especially under abnormal glucose metabolism.
文摘Acute obstruction of the right coronary ar-tery(RCA)can lead to right ventricular myocardial infarction(MI),which rarely lead to cardiogenic shock(CS).Hemodynamic sta-bility could be restored through fluid resuscitation and vasoactive drugs in most circumstances.Here,we present a highly representative case of refractory CS caused by massive right ventricular MI with api-cal aneurysm formation,who was successfully treated with extracorporeal membrane oxygenation(ECMO)post severe complication of acute right coronal dis-section.
基金the Major State Research Development Program of China(No.2017YFC0908701)the National Natural Science Foundation of China(No.81400262).
文摘To the Editor:The coagulation system is a complex regulatory system in the human body.In this case,the young patient had various vital thrombosis,including cerebral venous sinus thrombosis(CVST),coronary thrombosis,and left ventricular thrombus.However,the patient had neither hypercoagulable-related diseases nor risks nor coagulative or fibrinolytic protein deficiency.[1] Further genetic testing did not show the usual gene mutations relevant to coagulation dysfunction.W e report such a patient with a slight elevation in coagulation FVIII activity and a rare FVIII gene duplication.
