The regulatory variant rs17612742 confers the risk of large artery atherosclerotic stroke by increasing the expression of endothelin receptor type A

Genome-wide association studies have found that rs17612742 increases the risk of large artery atherosclerotic stroke.The rs17612742 was located in the intron region of Endothelin receptor type A(NRA),which was cellular and gender-heterogeneous.Functional genomics studies of rs17612742 were carried out through some public databases,and it was found that rs17612742 was located in the chromatin open region and promoted the expression of NRA.Compared with the control group,EDNRA expression increased in middle cerebral artery occlusion exposed rodents.However,age heterogeneity of EDNRA expression under physiological and pathological conditions was not observed.In addition,we also discussed how to conduct further empirical studies to provide evidence that rs17612742 confers the risk of large artery atherosclerotic stroke by increasing the expression of NRA.

Atherosclerotic aortic plaques detected by transesophageal echocardiography

Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD). Methods In 50 patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥50%was considered to be due to coronary artery disease, whereas the thickness of the intima ≥1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34 cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9%and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9%and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single-vessel disease had thoracic aortic plaques, 92 percent of the patients with two vessel disease and 100 percent of the patients with three vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detecting atherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.

Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis

Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.

Effect of Huanshuai Recipe Oral Liquid (缓衰口服液) on Renal Dysfunction Progression in Patients with Atherosclerotic Renal Artery Stenosis

Objective： To investigate the effect of Huanshuai Recipe Oral Liquid （缓衰口服液, HSR） on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis （ARAS）. Methods： A total of 52 ARAS patients with the Chinese medicine （CM） syndrome of qi deficiency and blood stasis, phlegm and dampness retention were recruited and randomly assigned into the treatment group （36 cases） and the control group （16 cases）. Both groups received a basic treatment （high-quality low-protein diet, blood pressure control, lipid-lowering, correcting the acidosis, etc.）. In addition, the treatment group received 20 mL HSR and the control group received placebo, 3 times a day for 6 months. Renal function （serum creatinine, blood urea nitrogen and uric acid） and blood lipids （cholesterol, triglycerides and low density lipoprotein） were examined monthly. The estimated glomerular filtration rate （eGFR） and CM syndrome score were compared between groups. Results： After treatment, compared with the control group, the serum creatinine level, uric acid level and CM syndrome score of the treatment group were significantly decreased （P〈0.05 or P〈0.01）, and the eGFR in the treatment group were significantly increased （P〈0.05）. Conclusion： HSR can effectively improve the renal function and clinical symptoms of ARAS patients.

Molecular imaging of plaques in coronary arteries with PET and SPECT

Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lu-men stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increas-ingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography （PET） and single photon emission computed tomography （SPECT） has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging tech-niques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coro-nary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.

Two-stent strategy for renal artery stenosis with bifurcation lesion

Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bifurcation lesion are described.In cases 1 to 3,a single-stent strategy was first adopted.However,these three patients were converted to a two-stent strategy for bailout stent implantation in the side branches.In cases 4 and 5,a simultaneous kissing stent technique was performed.Angiography showed that the reference vascular diameter of the main branch was much larger than those of the side branches.Although obvious residual stenosis existed in cases 1 to 3 after stent implantation,no obvious residual stenosis was seen in cases 4 and 5.Renal artery duplex sonography was performed in cases 1 through 5 at 6,7,7,8,and 6 months,respectively,after the procedures.No evidence of restenosis or occlusion was seen.In conclusion,stent implantation with the simultaneous kissing stent technique may result in more simple and more satisfactory immediate angiographic results.