Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment

Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescription of prostacyclin analogues,thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na^+,K^+-ATPase(phosphodiesterase inhibitor),ALA,dihomo-γ-linolenic acid(DGLA),ω-3 polyunsaturated fatty acids(ω-3 PUFAs),and the simultaneous prescription of ALA,ω-3 PUFAs and DGLA,but the future investigations are needed.Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological,in the foreground midodrine and fludrocortisone acetate,treatment methods are necessary.

Risk factors for adverse cardiac events in adults with fulminant myocarditis during hospitalization

BACKGROUND Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.AIM To analyze the predictors of in-hospital major adverse cardiovascular events(MACE) in patients diagnosed with fulminant myocarditis.METHODS We included a cohort of adult patients diagnosed with fulminant myocarditis who were admitted to Beijing Anzhen Hospital from January 2007 to December2017. The primary endpoint was defined as in-hospital MACE, including death,cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics,clinical history, characteristics of electrocardiograph and ultrasonic cardiogram,laboratory examination, and treatment were recorded. Multivariable logistic regression was used to examine risk factors for in-hospital MACE, and the variables were subsequently assessed by the area under the receiver operating characteristic curve(AUC).RESULTS The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis revealed that baseline QRS duration > 120 ms was the independent risk factor for in-hospital MACE(odds ratio = 4.57, 95%CI: 1.23-16.94, P = 0.023). The AUC of QRS duration > 120 ms for predicting in-hospital MACE was 0.683(95%CI: 0.532-0.833, P = 0.03).CONCLUSION Patients with fulminant myocarditis has a poor outcome. Baseline QRS duration is the independent risk factor for poor outcome in those patients.

Cardiac surgery in patients with liver cirrhosis:Risk factors for predicting mortality

AIM:To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality.METHODS:We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and2012.Child-Turcotte-Pugh(Child)classification and Model for End-Stage Liver Disease(MELD)score were used to assess the severity of liver cirrhosis.The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient.Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery.Multivariate Cox proportional hazard models were applied to estimate the hazard ratios(HR)of predictors for mortality.The Kaplan-Meier method was used to generate survival curves,and the survival rates between groups were compared using the log-rank test.RESULTS:There were 30 patients in Child class A,20in Child B,and five in Child C.The hospital mortality rate was 16.4%.The actuarial survival rates were 70%,64%,56%,and 44%at 1,2,3,and 5 years after surgery,respectively.There were no significant differences in major postoperative complications,and early and late mortality between patients with mild and advanced cirrhosis.Multivariate logistic regression showed preoperative serum bilirubin,the EuroSCORE and coronary artery bypass grafting(CABG)were associated with early and late mortality;however,Child class and MELD score were not.Cox regression analysis identified male gender(HR=0.319;P=0.009),preoperative serum bilirubin(HR=1.244;P=0.044),the EuroSCORE(HR=1.415;P=0.001),and CABG(HR=3.344;P=0.01)as independent risk factors for overall mortality.CONCLUSION:Advanced liver cirrhosis should not preclude patients from cardiac surgery.Preoperative serum bilirubin,the EuroSCORE,and CABG are major predictors of early and late mortality.

Risk Factors Associated with Anthracycline Induced Cardiac Dysfunction in Pediatric Patients

Anthracyclines (i.e., doxorubicin, daunorubicin) have significant impact on outcome in many pediatric chemotherapy protocols and therefore remain the mainstay of treatment. The objective of this study was to identify the risk factors for anthracycline induced cardiac dysfunction in pediatric patients. Multiple logistic regression model was applied to assess the risk factors for development of cardiac dysfunction. 110 pediatric oncology patients were available for final analysis. 75 (66%) children were males and mean age was 74 ± 44 months. ALL (n = 70, 64%) was the most common primary diagnosis followed by lymphoma (n = 19;17%) and AML (n = 12, 11%). Daunorubicin alone or in combination with doxorubicin was used in (n = 94, 85%) patients and cumulative dose n = 95;86%) children. 24 (22%) children received radiation therapy as per protocol and sepsis were observed in 47 (43%) cases. Post anthracycline, 15 (14%) children had cardiac dysfunction within a month;out of them 10/15 (67%) had isolated diastolic dysfunction, while 28 (25%) developed dysfunction within a year. 19 (17%) had pericardial effusion. 11 expired and out of them, 7 had significant cardiac dysfunction. Cumulative dose > 300 mg/m2 (p p = 0.009;AOR 3.5) and sepsis (p = 0.002;AOR 2.6) were found to be independent risk factors associated anthracycline induced cardiac dysfunction. At univariant level use of daunorubicin alone or in combination therapy (p p 0.048, OR 9.7) were also found statistically significant. In conclusion anthracycline induced cardiac dysfunction is mostly related to cumulative dose > 300 mg/m2, use of Daunorubicin alone or in combination with doxorubicin, mode of delivery, radiation therapy and sepsis. Regular long term follow-up with cardiologist is the key point for early diagnosis and therapy for a long term survival.

Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass:A retrospective observational study

Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardiac surgery with CPB and identify associated risk factors.Methods:The current investigation was an observational,retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017.Data were obtained from the hospital database.Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.Results:Of 395 patients,137(34.7%)had a prolonged ICU LOS(>72.0 h),and the median ICU LOS was 50.9 h.Several variables were found associated with prolonged ICU LOS:duration of CPB,prolonged mechanical ventilation and non-invasive assisted ventilation use,PaO2/FiO2 ratios within 6 h after surgery,type of surgery,red blood cell infusion during surgery,postoperative atrial arrhythmia,postoperative ventricular arrhythmia(all P<0.05).Conclusions:These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS,enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.

Assessing myocardial indices and inflammatory factors to determine anxiety and depression severity in patients with chronic heart failure

BACKGROUND Patients with chronic heart failure(CHF)have a progressive disease that is associated with poor quality of life and high mortality.Many patients experience anxiety and depression(A&D)symptoms,which can further accelerate disease progression.We hypothesized that indicators of myocardial function and inflammatory stress may reflect the severity of A&D symptoms in patients with CHF.Changes in these biomarkers could potentially predict whether A&D symptoms will deteriorate further in these individuals.AIM To measure changes in cardiac and inflammatory markers in patients with CHF to determine A&D severity and predict outcomes.METHODS We retrospectively analyzed 233 patients with CHF treated at the Jingzhou Hospital,Yangtze University between 2018-2022 and grouped them according to Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores.We compared clinical data in the no-A&D,mild-A&D,moderate-A&D,and severe-A&D groups,the SAS and SDS scores with the New York Heart Association(NYHA)functional classification,and cardiac markers and inflammatory factors between the no/mild-A&D and moderate/severe-A&D groups.Regression analysis was performed on the markers with P<0.05 to determine their ability to predict A&D severity in patients and the area under the receiver operating characteristic curve(AUROC)was used to evaluate their accuracy.RESULTS In the inter-group comparison,the following variables had an effect on A&D severity in patients with CHF:NYHA class,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,N-terminal pro-brain natriuretic peptide(NT-proBNP),interleukin-6(IL-6),and tumor necrosis factor-alpha(P<0.05).Other variables did not differ significantly between the A&D groups(P>0.05).In addition,we found that higher NYHA classes were associated with higher the SAS and SDS scores(P<0.05).Regression analysis showed that LVEF,NTproBNP,and IL-6 were independent risk factors for A&D severity(P<0.05).Among them,NT-proBNP had the best predictive ability as a single indicator(AUROC=0.781).Furthermore,the combination of these three indicators exhibited a good predictive effect toward discriminating the extent of A&D severity among patients(AUROC=0.875).CONCLUSION Cardiac and inflammatory biomarkers,such as LVEF,NT-proBNP,and IL-6,are correlated with A&D severity in patients with CHF and have predictive value.

Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication:a single-center cohort study

BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.

Effect of trimetazidine combined with bisoprolol on the cardiac function, ventricular remodeling and neuroendocrine factors in patients with chronic heart failure

Objective:To study the effect of trimetazidine combined with bisoprolol on the cardiac function, ventricular remodeling and neuroendocrine factors in patients with chronic heart failure.Methods: A total of 52 patients with chronic heart failure who were treated in our hospital between January 2012 and November 2015 were collected and divided into the control group (n=26) who received bisoprolol therapy and the observation group (n=26) who received trimetazidine combined with bisoprolol therapy according to the double-blind randomized control method, and both groups were treated for 3 months. Before treatment and after 3 months of treatment, cardiac color Doppler diasonograph was used to determine the levels of cardiac function parameters and ventricular remodeling parameters, and RIA method was used to determine the levels if peripheral blood neuroendocrine factors.Results: Before treatment, the differences in cardiac function, ventricular remodeling and neuroendocrine factor levels were not statistically significant between two groups of patients. After 3 months of treatment, cardiac function parameters LVEDd and LVESD levels of observation group were lower than those of control group while LVEF level was higher than that of control group, and ventricular remodeling parameters LVPWT, IVSS, PWD, PWS and LVMI levels were lower than those of control group;peripheral blood neuroendocrine factors NE, ALD, AngⅡ, ANP and ET contents of observation group were lower than those of control group.Conclusion:Trimetazidine combined with bisoprolol can optimize the cardiac function, suppress the ventricular remodeling process and regulate the neuroendocrine factor secretion in patients with chronic heart failure, and it contributes to the patients' overall optimization.

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.AIM To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.METHODS This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome.Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.RESULTS After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

Survey on the Readiness for Hospital Discharge and Its Influencing Factors among Patients with Cardiac Valve Replacement

Background: There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the increase in hospital bed turnover rate, the average hospital stay of patients undergoing CVR surgery has been significantly shortened, and thus the patients are still in the recovery stage rather than fully recovered when they are discharged from the hospital. Good preparation for discharge can improve patients’ post-discharge self-care ability, reduce the risk of re-admission, and save medical resources. Objective: To describe the status of readiness for hospital discharge among postoperative patients that have undergone CVR, and to explore its influencing factors. Methods: The general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of discharge Teaching Scale were utilized to investigate 130 post-CVR patients admitted to the Cardiothoracic Surgery Department of a tertiary A-Class hospital in Guangzhou from July 2019 to October 2020. Results: The Readiness for Hospital Discharge Scale was at a moderate level with a total score of 163.88 ± 39.082, while the Quality of Discharge Teaching Scale was also at a moderate level with a total score of 194.09 ± 40.643. Multiple linear regression analysis revealed that the quality of discharge guidance, gender, and occupation were the influencing factors of CVR patient’s readiness for hospital discharge. These three variables jointly explained 45.8% of the total variation. Conclusion: The level of CVR patients’ readiness for hospital discharge is at a moderate level, and the quality of discharge guidance positively affects patients’ readiness for discharge. Therefore, in clinical work, attention should be paid to patient discharge guidance. Personalized health education should be implemented to improve the quality of patient guidance.

Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

Objectives To evaluate the effect of different styles of coronary heart disease （CHD）, different regions of acute myocardial infarction （AMI）, its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD （NoCHD） were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris （SAP） 26, unstable angina pectoris（UAP） 53, acute myocardial infarction （AMI） 140 and old myocardial infarction （OMI） 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct （Aa,n = 53）, acute inferior myocardial infarction （Ai, n=54） and Aa＋Ai （n=33） based on ECG. Cardiac parameters： end-diastolic interventricular septum thickness（IVSd）, end-diastolic left ventricular internal diameter （LVd）, left ventricular mass （LM）, end-diastolic left ventricular volume （EDV）, end-systolic left ventricular volume （ESV） and left ventricular ejection fraction（LVEF） were measured by ACUSON 128XP/10 echocardiography. Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP （P〈0.05-0.0001）. LM was mainly increased in patients with OMI （P〈0.01） and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa＋Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF was significantly decreased, and LVd and LM increased in AMI patients with antecedent hypertension, compared to patients without hypertension （P〈0.001）. Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction, especially Aa and Aa＋Ai, is one of the most important causes of left ventricular remodeling and cardiac dysfunction. Multiple vessel stenosis and systolic blood pressure at the onset of myocardial infarction reduce LVEF in AMI patients. Antecedent hypertension may accelerate the effect of AMI on cardiac remodeling and dysfunction. Therefore primary and secondary preventions of CHD are critical for protecting heart from remodeling and dysfunction.

Effect of recombinant human brain natriuretic peptide on serum inflammatory factors, neuroendocrine hormones and cardiac function in patients with acute myocardial infarction complicated with heart failure

Objective:To investigate the effect of recombinant human brain natriuretic peptide (BNP) on inflammatory factors, neuroendocrine hormones and cardiac function indexes in patients with acute myocardial infarction complicated with heart failure.Methods:A total of91 cases of acute myocardial infarction with heart failure patients were divided into the control group (n=44) and observation group (n=47) according to the random data table, two groups of patients were given conventional treatment, based on this, the control group was given intravenous infusion of Nitroglycerin Injection treatment, the observation group received intravenous injection of recombinant human brain natriuretic peptide treatment, compared serum inflammatory factors, neuroendocrine hormone and cardiac function and other indexes of two groups before and after treatment.Results: there was no significant difference between the two groups before treatment. After treatment, the levels of TNF-α, hs-CRP, IL-6, MCP-1, LVESD and LVEDD in the two groups were significantly lower than those within the group before treatment, and the observation group was significantly lower than the control group;The two groups after treatment LVEF levels were significantly higher than those in the group before treatment, and the observation group was significantly higher than that of control group;the observation group after treatment PRA, Ang II and ALD and NE levels were significantly lower than those before treatment, and was significantly lower than the control group after treatment, the difference was significant, PRA, Ang, ALD and NE levels of control group before and after the treatment was no significant difference.Conclusion:recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction with heart failure can effectively reduce the serum inflammatory factors and neuroendocrine hormone levels, improve heart function, and have a certain clinical value.

Co-expression of estrogen receptor and nerve growth factor in rat intrinsic cardiac ganglia

BACKGROUND： Previous studies have shown that neurons expressing estrogen receptor and nerve growth factor exist in the intrinsic cardiac ganglia in rats. However, it remains to be shown whether estrogen receptor and nerve growth factor are co-expressed within these cells. OBJECTIVE： To determine whether estrogen receptor and nerve growth factor are co-expressed in intrinsic cardiac ganglia. DESIGN, TIME AND SETTING： This cellular morphology observational study was performed at the immunohistochemistry Department, Medicine School, Wuhan University of Science and Technology, between March and July in 2007. MATERIALS： Mouse anti-estrogen receptor and rabbit anti-nerve growth factor polyclonal antibody, biotinylated goat anti-mouse IgG, and biotinylated goat anti-rabbit IgG were provided by Wuhan Boster, China. METHODS： Ten healthy, Wistar rats were included in the present study. Ten sections of intrinsic cardiac ganglia from the atrial posterior wall were randomly selected from each rat to perform estrogen receptor and nerve growth factor double-labeling immunohistochemical staining. MAIN OUTCOME MEASURES： Expression of estrogen receptor and nerve growth factor in intrinsic cardiac ganglia of rats. RESULTS： Immunohistochemistry results demonstrated expression of estrogen receptor and nerve growth factor in rat intrinsic cardiac ganglia, and double-labeling revealed co-expression of estrogen receptor and nerve growth factor in intrinsic cardiac ganglial cells. CONCLUSION： Estrogen receptor and nerve growth factor were shown to be co-expressed in rat intrinsic cardiac ganglial cells.

Cardiovascular disease: Risk factors and applicability of a risk model in a Greek cohort of renal transplant recipients

AIM To investigate the incidence and the determinants of cardiovascular morbidity in Greek renal transplant recipients(RTRs) expressed as major advance cardiac event(MACE) rate. METHODS Two hundred and forty-two adult patients with a functioning graft for at least three months and availabledata that were followed up on the August 31, 2015 at two transplant centers of Western Greece were included in this study. Baseline recipients' data elements included demographics, clinical characteristics, history of comorbid conditions and laboratory parameters. Follow-up data regarding MACE occurrence were collected retrospectively from the patients' records and MACE risk score was calculated for each patient. RESULTS The mean age was 53 years(63.6% males) and 47 patients(19.4%) had a pre-existing cardiovascular disease(CVD) before transplantation. The mean estimated glomerular filtration rate was 52 ± 17 mL /min per 1.73 m2. During follow-up 36 patients(14.9%) suffered a MACE with a median time to MACE 5 years(interquartile range: 2.2-10 years). Recipients with a MACE compared to recipients without a MACE had a significantly higher mean age(59 years vs 52 years, P < 0.001) and a higher prevalence of pre-existing CVD(44.4% vs 15%, P < 0.001). The 7-year predicted mean risk for MACE was 14.6% ± 12.5% overall. In RTRs who experienced a MACE, the predicted risk was 22.3% ± 17.1% and was significantly higher than in RTRs without an event 13.3% ± 11.1%(P = 0.003). The discrimination ability of the model in the Greek database of RTRs was good with an area under the receiver operating characteristics curve of 0.68(95%CI: 0.58-0.78).CONCLUSION In this Greek cohort of RTRs, MACE occurred in 14.9% of the patients, pre-existing CVD was the main risk factor, while MACE risk model was proved a dependable utility in predicting CVD post RT.

Xuebijing alters tumor necrosis factor-alpha, interleukin-1beta and p38 mitogen activated protein kinase content in a rat model of cardiac arrest following cardiopulmonary resuscitation

We established a rat model of cardiac arrest by clamping the endotracheal tube of adult rats at expiration. Twenty-four hours after cardiopulmonary resuscitation, nerve cell injury and expression of tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase content were increased. Rats injected with Xuebijing, a Chinese herb compound preparation, exhibited normal cellular structure and morphology, dense neuronal cytoplasm, and decreased tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase expression at 24 hours following cardiopulmonary resuscitation. These data suggest that Xuebijing can attenuate neuronal injury induced by hypoxia and reperfusion during cardiopulmonary resuscitation.

Neuronal injury and tumor necrosis factor-alpha immunoreactivity in the rat hippocampus in the early period of asphyxia-induced cardiac arrest under normothermia

Low survival rate occurs in patients who initially experience a spontaneous return of circulation after cardiac arrest（CA）. In this study, we induced asphyxial CA in adult male Sprague-Daley rats, maintained their body temperature at 37 ± 0.5°C, and then observed the survival rate during the post-resuscitation phase. We examined neuronal damage in the hippocampus using cresyl violet（CV） and Fluore-Jade B（F-J B） staining, and pro-inflammatory response using ionized calcium-binding adapter molecule 1（Iba-1）, glial fibrillary acidic protein（GFAP）, and tumor necrosis factor-alpha（TNF-α） immunohistochemistry in the hippocampus after asphyxial CA in rats under normothermia. Our results show that the survival rate decreased gradually post-CA（about 63% at 6 hours, 37% at 1 day, and 8% at 2 days post-CA）. Rats were sacrificed at these points in time post-CA, and no neuronal damage was found in the hippocampus until 1 day post-CA. However, some neurons in the stratum pyramidale of the CA region in the hippocampus were dead 2 days post-CA. Iba-1 immunoreactive microglia in the CA1 region did not change until 1 day postCA, and they were activated（enlarged cell bodies with short and thicken processes） in all layers 2 days postCA. Meanwhile, GFAP-immunoreactive astrocytes did not change significantly until 2 days post-CA. TNF-α immunoreactivity decreased significantly in neurons of the stratum pyramidale in the CA1 region 6 hours post-CA, decreased gradually until 1 day post-CA, and increased significantly again 2 days post-CA. These findings suggest that low survival rate of normothermic rats in the early period of asphyxia-induced CA is related to increased TNF-α immunoreactivity, but not to neuronal damage in the hippocampal CA1 region.

A Cross-Sectional Survey to Determine the Prevalence of Cardiovascular Disease Risk Factors in an Understudied Population in Sierra Leone

To document the prevalence of risk factors for cardiovascular disease in an unstudied community, a survey of 130 participants from different areas of Sierra Leone was performed. The focus was on cardiovascular disease because its prevalence had not been studied and World Health Organization (WHO) reports on Non-Communicable Diseases (NCD) prevalence were extrapolations and not from actual data. Resting blood pressure, fasting blood glucose, fasting lipid levels and carotid intima media thickness (CIMT) were measured. Mean blood pressure in men was slightly lower than in women (132/87 mmHg and 139/90 mmHg respectively), mean fasting blood glucose levels were <100 mg/dL in both groups and mean fasting total cholesterol was higher in women than in men (206 mg versus 193.5 mg/dL). Mean fasting low density lipoprotein levels were similar in both groups, 129 mg/dL in men and 133 mg/dL in women. Mean fasting high density cholesterol was 47.2 mg/dL in men and 55.5 mg/dL in women and CIMT values were similar in both groups, with 60% above the 75th percentile. This study demonstrated a prevalence of cardiovascular risk factors in this population with mean BP placing both men and women in pre-hypertension or stage 1 hypertension ranges and elevated mean low density lipoprotein levels. Fasting total cholesterol, blood glucose and high density lipoprotein were within normal ranges. Mean CIMT values for men and women placed them at risk for subclinical atherosclerosis.

Effect of rosuvastatin on inflammatory factor, oxidative stress and cardiac function in patients with chronic heart failure

Objective:To explore effect of rosuvastatin on inflammatory factor, oxidative stress and cardiac function in patients with chronic heart failure.Method: A total of 200 cases of patients with chronic heart failure who were admitted in our hospital from July 2015 to December 2016 and were divided randomly into observation group 100 cases and control group 100cases, both groups patients were given conventional treatment of chronic heart failure, observation group was given rosuvastatin on this basis. Compared interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypersensitivity-C reaction protein (hs-CRP), superoxidedismutase (SOD), malondialdehyde (MDA) and cardiac function before and after treatment in two groups.Results: IL-6, TNF-α, hs-CRP level after treatment was lower than before treatment in observation group and after treatment in control group. The difference was significant;IL-6, TNF-α, hs-CRP level after treatment was no significant difference with before treatment in control group. SOD level was (172.71±5.22) U/mL after treatment in observation group, higher than before treatment, moreover higher than after treatment in control group;MDA level was (3.99±0.31) nmol/mL after treatment in observation group, lower than before treatment, moreover lower than after treatment in control group;there was no significant difference in SOD, MDA level between before and after treatment in control group. After treatment, LVEDD, LVEDF were (52.19±1.33) mm, (36.33±2.82) mm, (59.88±1.62) mm, (42.41±3.43) mm in both groups, all was lower than before treatment, and observation group was lower than control group, there was statistical significant difference;LVEF of two groups was (49.90±6.26)%, (42.72±5.14)% respectively after treatment, higher than before treatment, and observation group was higher than control group, there was statistical significant difference. Conclusion: Rosuvastatin was able to inhibit inflammatory factor, oxidative stress, moreover improved cardiac function in patients with chronic heart failure.

Effect of granulocyte colony-stimulating factor on the cardiac function and endothelial function in patients with myocardial infarction after PCI

Objective:To explore the effect of granulocyte colony-stimulating factor (G-CSF) on the cardiac function and endothelial function in patients with myocardial infarction after percutaneous coronary intervention (PCI).Methods: A total of 76 patients with acute myocardial infarction treated in our hospital between August 2012 and January 2016 were collected and divided into observation group and control group (n=38) according to the randomized parallel control method. Control group of patients received PCI treatment, and observation group of patients received G-CSF treatment (5 μg/kg, subcutaneous injection, 3 times/d, for 5 d) after PCI. 2 weeks after treatment, color Doppler diasonograph was used to detect cardiac function parameters, RIA method was used to detect serum cardiac function indexes, and enzyme-linked immunosorbent assay (ELISA) was used to detect serum endothelial function indexes.Results:Before treatment, differences in serum cardiac function index and endothelial function index levels were not statistically significant between two groups of patients. 2 weeks after treatment, cardiac output (CO) and stroke volume (SV) levels of observation group were significantly higher than those of control group while left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) levels were lower than those of control group;serum heart-type fatty acid-binding protein (H-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and Galectin-3 levels of observation group were lower than those of control group, endothelin-1 (ET-1) level was lower than that of control group, and nitric oxide (NO) level was higher than that of control group.Conclusion:G-CSF can enhance the cardiac function after PCI and also optimize the endothelial function in patients with myocardial infarction.

Allograft Inflammatory Factor-1 in Cardiac Ischemia Re-perfusion Injury: Release of Molecular Markers in an <i>in Vitro</i>Setting

Initial ischemia/reperfusion injury (IRI) may have an impact on recipient immune responses after transplantation. Allograft inflammatory factor-1 (AIF-1) has been implicated in the regulation of inflammation associated with organ rejection. We hypothesized that it is either passively released from injured tissues during organ procurement, or actively secreted by allograft infiltrating cells contributing to allograft dysfunction. We investigated the impact of IRI in an in vitro study of human heart tissue during the process of transplantation. The mRNA expression levels for both isoforms of the AIF-1, I2 and I3 were significantly increased after 30 minutes reperfusion (AIF-1 I2: p 0.01 vs. AIF-1 I3: p 0.005). Expression levels for IL-18 and the TLRs were increased after 30 minutes of reperfusion. Only IL-18 and TLR-2 were statistically significant (IL-18: p 0.0001 vs. TLR-2: p 0.01). The mRNA expression levels for AIF-1 I2 and IL-18 were decreased from the original levels of ischemia after 60 and 90 minutes reperfusion. The TLR-2 and -4 were presented with minimal levels of reduction after 60 minutes. However, mRNA expression levels for all were decreased to the original levels of ischemia after 90 minutes, except for AIF-1 I3, but the difference was not statistically significant. AIF-1 and IL-18 were specifically detected in myocytes and interstitial tissues by immunohistochemistry (IHC) stain after IRI. TLR-4 was non-specific, and TLR2 was minimally expressed. The study discusses the evidence supporting that the AIF-1 may have therapeutic potential for strategies in the control of innate immune responses early on, after transplantation.