2004 Vol. 1, No. 2
Cardiovascular disease takes place in a border-free world. The challenge at the American College of Cardiol-ogy (ACC) and anywhere else in the world is to hold pa-tient care above the artificial barriers raised by geopoliti-cal issues. Fundamentally, the goal of ACC members or of any cardiology societies in the world is to provide ex-cellent patient care. Cardiovascular disease is essentially the same throughout the world. Where there are minor variations among individuals, as clinicians we find price-less opportunity to learn. Expanding — rather contracting - our experience base helps us as individuals to realize our best potential as practitioners.
On behalf of all the editors and editorial board mem-bers, I would like to announce that the inaugural issue of the Journal of Geriatric Cardiology (JGC) was pub-lished after over two years of preparation, and the JGC will be continuously published. The JGC was born in accordance with the tough challenge of higher prevalence of cardiac diseases and/or complicated with other organ dis-eases in the elderly accompanied by the rapid growing number of the aged. Basing on the current conditions, we provide this forum for exchanging opinions in geriatric medicine worldwide, especially when China has a much higher status in the world and geriatric cardiology in Chi-na is progressing at a fast rate.
A growing body of evidence explicitly suggests the significant role of inflammatory processes in the develop-ment and progressive deterioration of vascular diseases and cardiomyopathies. In recent years, a large variety of infections have been reported to be associated with the development of cardiomyopathy, the pathogenic factors include rickets, bacteria, protozoa and other parasites, and also, at least 17 viruses. Thanks to the latest de-velopment of molecular biology techniques, quite a num-ber of virus genomes have been identified in heart tissues taken from biopsies and/or autopsies. Thus, they have provided further and stronger evidence to support the pathogenic linkage between viral infections and myocardial dysfunction. Currently, there is a consensus that virus-es are one of the important causes of myocarditis at least in certain areas of the world, North America and Eu-rope .
The emergence of cardiac disease as the number one world-wide cause of death justifies efforts to identify individ-uals at higher risk for preventive therapy. The metabolic syn-drome, originally described by Reaven, has been associated with higher cardiovascular disease risk. Type II diabetes is also a frequent sequela.
Cardiovascular disease is one of the major health con-cerns of modern societies. In the United States in the year 2001 alone, an estimated 64 million people had had one or more forms of cardiovascular disease, claiming almost one million lives ,38.5 percent of all deaths (American Heart Association).
Current therapies for myocardial infarction and congestive heart failure are limited in efficacy or in applicability. The plasticity of adult stem cells and cellular transplantation offer a novel therapeutic approach to im-prove cardiac function. This review describes the latest progress in research, summarizes recent studies of adult stem cells and their application in myocardial regenerative medicine in China and abroad, and discusses the future direc-tions of cell transplantation as a new therapy to repair injured hearts.
To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary an-giography. Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holier recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations ^4% and apnea-hypopneas) , heart rates, and ST-seg-ment depressions ( ^ Imm, ^ 1 min) . Results Nocturnal ST-segment depressions occurred in 37% of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients . This temporal association was seen in 21 % of the patients with nocturnal ST-segment depressions, more frequently in men (P <0.05) and more frequently in those with severe disordered breathing (P <0.05) . Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or de-saturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are com-mon in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely dis-ordered breathing.
The logo of the Institute of Geri-atric Cardiology ( IGC) is composed of two capital letters of H . The upper " H " symbolizes " High " , meaning that the objective of IGC is to keep high level in medical re-searches, therapeutic techniques and service quality. The lower " H" refers to " Heart and Health", which tells the critical role of IGC in providing high level medical care in the field of cardiology for the patients.
Background The metabolic syndrome (MS) is characterized by a specific clustering of risk factors, including dyslipidemia, central adiposity, systemic hypertension, insulin resistance, and dysglycemia. It is associated with an increased risk of developing cardiovascular disease (CVD). Accurate data on prevalence and characteristics of MS will facilitate the development of preventive strategies for CVD. Objective To estimate accurately the prevalence of MS among Vietnamese adults with the usual criteria or with the criteria modified for Asian populations. Design and methods We studied a representative, cross-sectional, population-based sample of 856 subjects (mean age 52.82±16.36) classified in three age groups from 15-34 years, 35-54 years and > 54 years of age, living in Khanh Hoa Province, Viet Nam. MS was diagnosed according to the criteria defined by the Third Report of the National Cholesterol Education Program Expect Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) ( NCEP-ATP III) and by the modified criteria for some Asian populations in which the waist circumference (WC) is considered abnormal if it is > 90 cm for males and > 80 cm for females. Results Using the NCEP-ATP III criteria, the prevalence of MS in the studied population was 10.0% (CI 95% : 8.1-12.3). It was 2.4 % in the 15-34 age group (men 4.5% and women 1.2%), 5.2% (men 6.3% , women 4.5%) in 35-54 age group and 15.8% (men 9.7% , women 21.7%) in over 54 age group, respectively. And it was more common in women than in men (11.7% vs 8.0% , P 54 age group. Prevalence of modified WC feature was 10.9% for men and 23 .6 % for women. Conclusions MS is more accurately identified among Vietnamese adults using the modified criterion of the WC for some Asian populations. Its prevalence is similar to that in the developed countries.
Objective To investigate the potential of adult mesenchymal stem cells (MSCs) derived from human bone marrow to undergo cardiomyogenic differentiation after exposure to 5-azacytidine (5-aza) in vitro. Methods A small bone marrow aspirate was taken from the iliac crest of human volunteers, and hMSCs were isolated by 1.073 g/mL Percoll and propagated in the right cell culturing medium as previously described. The phenotypes of hMSCs were characterized with the use of flow cytometry. The hMSCs were cultured in cell culture medium (as control) and medium mixed with 5-aza for cellular differentiation. We examined by immunohistochemistry at 21 days the inducement of desmin, cardiac-specific cardiac troponin I (cTnl), GATA4 and connexin-43 respectively. Results The hMSCs are fibroblast-like morphology and express CD44+ CD29+ CD90+ / CD34-CD45' CD31" CDlla'. After 5-aza treatment, 20-30% hMSCs connected with adjoining cells and coalesced into myotube structures after 14 days. Twenty-one days after 5-aza treatment, immunofluorescence showed that some cells expressed desmin, GATA4, cTnl and connexin-43 in 5,10 /.imol/L 5-aza groups, but no cardiac specific protein was found in neither 3 jumol/L 5-aza group nor in the control group. The ratio of cTnl positively stained cells in 10 jumol/L group was higher than that in 5 jumol/L group (65.3±4.7% vs48.2±5.4%, P < 0. 05). Electron microscopy revealed that myofilaments were formed. The induced cells expressed cardiac-myosin heavy chain ( MyHC) gene by reverse transcription-polymerase chain reaction (RT-PCR). Conclusions Theses findings suggest that hMSCs from adult bone marrow can be differentiated into cardiac-like muscle cells with 5-aza inducement in vitro and the differentiation is in line with the 5-aza concentration.
The Journal of Geriatric Cardiology (JGC) started publication in September 2004. To announce the publication of its first issue, a ceremony was held at China Grand Hotel in Beijing on October 18th, 2004 during the 15th Great Wall International Congress of Cardiology. Many guests were present at the ceremony. Editorial board members, such as Drs. Dayi HU, Zhongxiang LJN, Zhuming JIANG, Junheng LI, Fangyi QIAN, etc participated in the ceremony. Some journalists of medical media and editors of other medical journals in Beijing were also invited to the gathering. On behalf of the guests, Hailin LIU, Vice President of the Chinese Medical Association, made a speech expressing his congratulations. He said that the JGC is th first English journal dedicated to cardiology in China, and its publication is a significant event in the field of cardiology and geriatrics. It is a unique journal in many aspects including the constitutes of international editorial board members and authors, as well as its team of editors, especially in that it publishes editorial comments for those articles causing controversy. This special column may become a characteristic of the JGC and lead readers to a new way of thinking. The editorial team believe that the advent of JGC will certainly offer an excellent forum for the international academic exchange in geriatric cardiology between the eastern and western medical professionals.
Objective To examine whether the two vascular paracrine/autocrine factors, angiotensin II (Ang II) and endothelin, participate in the pathogenesis of arterial calcification. Methods Nicotine and vitamin D3 treated rats were studied. Vascular calcification was confirmed by using Von Kossa staining, measurement of calcium content, 45Ca2+ uptake assay and alkaline phosphatase (ALP) activity. The plasma and vascular Ang II and endothelin levels were measured by using radioimmunoassay. Angiotensinogen and endothelin mRNA levels were determined by RT-PCR. Results The arterial calcium content, 45Ca2 + uptake and ALP activity were increased in calcification groups compared with control (P < 0.01). Administration of the angiotensin receptor antagonist losartan, the endothelin receptor antagonist bosentan, and the angiotensin-converting enzyme inhibitor captopril reduced significantly the arterial calcium content, 45Ca2+ uptake and ALP activity. In addition, the plasma and aortic Ang II and endothelin contents, and vascular angiotensinogen and endothelin mRNA expression were significantly up-regulated (P < 0.05). Conclusions These findings suggest that functional renin-angiotensin system and endothelin pathway are involved in vascular calcification, and that activation of these systems could potentiate pathogenesis of arterial calcification.
Background One of the characteristics of atherosclerosis is a change in the content of extracellular matrix in the arterial wall. Gelatinase B, a member of the family of matrix metalloproteinase, can regulate extracellular matrix metabolism and play a role in the pathogenesis of atherosclerosis, coronaiy heart disease (CHD) and myocardial infarction (MI). Gelatinase B is polymorphic due to a C to T change at the position -1562 bp in the promoter region. Its relationship with gene product concentration in serum and its role in mediating the risk of CHD and MI in Germans is still unknown. Methods We enrolled 102 controls and 322 patients with angiographically documented CHD, including a sub-group of 173 patients with acute or chronic MI and 80 patients with acute coronary syndrome (ACS). All patients and controls were Germans and genotyped by polymerase chain reaction and digestion with SphI. Results We found that several classical risk factors for CHD and MI, including hypercholesterolemia and cigarette smoking, were significantly increased in CHD and MI patients compared with controls. Serum levels of gelatinase B and tissue inhibitor of metalloproteinase-1 were increased in the peripheral blood of patients with acute coronary syndrome. No significant differences in genotype or allelic frequencies between CHD, MI and control subjects of either men or women were found. Our search for a possible association of the polymorphisms with CHD and MI by logistic regression analysis was also negative. The serum concentrations of gelatinase B showed no differences between genotypes. Conclusions Our data showed that gelatinase B might provide an index of plaque activity in ACS, but gelatinase B protein was not affected by genotypes. Also, the T variant of gelatinase B was not associated with CHD or MI in Germans.
Objective To study the potential role of tumor necrosis factor-a (TNF-a) induction in the development of mucosal barrier dysfunction in rats caused by acute intestinal ischemia-reperfusion injury, and to examine whether pretreatment with monoclonal antibody against TNF-a (TNF-a MoAb) would affect the release of D(-)-lactate after local gut ischemia followed by reperfusion. Methods Anesthetized Sprague-Dawley rats underwent superior mesenteric artery occlusion for 75 min followed by reperfusion for 6 hr. The rats were treated intravenously with either TNF-a MoAb (20 mg/kg) or albumin (20 mg/kg) 30 min prior to the onset of ischemia. Plasma D(-)-lactate levels were measured in both the portal and systemic blood by an enzymatic spectrophotometric assay. Intestinal TNF-a mRNA expression as well as protein levels were also measured at various intervals. In addition, a postmortem examination was performed together with a macropathological evaluation based on a four-grade scoring system. Results Intestinal ischemia resulted in a significant elevation in D(-)-lactate levels in the portal vein blood in both the control and treatment groups ( P < 0.05). However, animals pretreated with TNF-a MoAb at 6 hr after reperfusion showed significant attenuation of an increase in both portal and systemic D(-)-lactate levels when compared with those only receiving albumin (P < 0.05). In the control animals, a remarkable rise in intestinal TNF-a level was measured at 0.5 hr after clamp release ( P < 0.01), however, prophylactic treatment with TNF-a MoAb completely annulled the increase of local TNF-a levels seen in the control animals. Similarly, after anti-TNF-a MoAb administration, intestinal TNF-a mRNA expression was markedly inhibited, which showed significant differences when compared with the control group at 0. 5 hr, 2 hr and 6 hr after the release of occlusion ( P < 0. 05-0. 01). In addition, the pathological examination showed marked intestinal lesions that formed during ischemia, which were much worse upon reperfusion, particularly at the 6 hr time point. These acute injuries were obviously attenuated in animals receiving TNF-a MoAb. Conclusions It appeared that acute intestinal ischemia was associated with failure of the mucosal barrier, resulting in increased plasma D(-)-lactate levels in both portal and systemic blood. These results suggest that TNF-a appears to be involved in the development of local damage associated with intestinal ischemic injury. Moreover, prophylactic treatment with TNF-a MoAb exerts preventive effects on ischemia/ reperfusion-induced circulating D (-)-lactate elevation and gut injury.
Objective To evaluate the sensitivity of arterial ketone body ratio as an indicator for multiple organ failure. Materials and methods The experimental model of multiple organ failure was made in adult and old rats by hypoperfusion-induced hemorrhagic shock. After blood sampling, the arterial acetoacetate, (3-hydroxybutyrate, total ketone body, ALT, AST, BUN, creatinine at 2, 4, 8 hr in hypoperfusion were examined to compare the differences of ketone body ratio and organ failure between adult and old rats. Hepatic and mitochondria! metabolism were assessed by comparing ketone body ratios (AcAc/(3-OHB) and free NAD+ /NADH ratios. Results Ketone body ratio in old rats at 2, 4, 8 hr after the induction of hemorrhagic shock decreased from 0. 68 to 0. 31, 0. 27 and 0.22, respectively. In adult rats, it decreased from 1.12 to 0.17, 0.12 and 0.09, respectively. Changes of ketone body ratio in the adult group were larger than in the elderly group ( P < 0.001). The development of multiple organ failure is associated with the time of hemorrhagic shock development. Conclusions There was a different ketone body ratio between multiple organ failure in the elderly (MOFE) and multiple organ failure (MOF) in general adults. Ketone body ratio is a better indicator than ALT and AST in reflecting hepatic function in the early status of MOF.