ISSN 1671-5411 CN 11-5329/R

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2015 Vol. 12, No. 2

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Relationship between lipoprotein (a) and micro/macro complications in type 2 diabetes mellitus: a forgotten target
Rocio Toro, Eduardo Segura, Jesus Millan Nunez-Cortes, Juan Carlos Pedro-Botet, Maribel Quezada-Feijoo, Alipio Mangas
2015, 12(2): 93-99. doi: 10.11909/j.issn.1671-5411.2015.02.001
Objectives Increased lipoprotein (a) serum concentrations seems to be a cardiovascular risk factor; this has not been confirmed in extracoronary atherosclerosis complications. We therefore wished to gain a deeper insight into relationship between the plasma concentra-tions of lipoprotein (a) and the micro- and macro-vascular complications of type 2 diabetes mellitus and to identify possible differences in this association. Methods This is a descriptive observational cross-sectional study. Two-hundred and seventeen elderly patients with type 2 diabetes mellitus were included from the internal medicine outclinic. Anthropometric data, analytical data (insulin reserve, basal and post-prandial peptide C, glycosylated hemoglobin, renal parameters, lipid profile and clinical data as hypertension, obesity, micro- and macrovas-cular complications were collected. Results Patients were grouped according to the type 2 diabetes mellitus time of evolution. The mean plasma concentration of lipoprotein (a) was 22.2 ± 17.3 mg/dL (22.1 ± 15.9 mg/dL for males, and 22.1 ± 18.4 mg/dL for females). Patients with hypertension, coronary heart disease, cerebrovascular accident, microalbuminuria and proteinuria presented a statistically significant increased level of lipoprotein (a). Similarly, the patients with hyperlipoprotein (a) (≥ 30 mg/dL) presented significantly increased levels of urea and total cholesterol. In the multivariate regression model, the level of lipoprotein (a) is positively correlated with coronary heart disease and diabetic nephropathy (P P Conclusions The elevation of plasma levels of lipoprotein (a) are associated with the development of coronary heart disease and diabe tic nephropathy. Therefore, we consider that the determination of lipoprotein (a) may be a prognostic marker of vascular complications in patients with type 2 diabetes mellitus.
Evaluation of CA125 and NT-proBNP values in patients undergoing transcatheter aortic valve implantation
Huseyin Ayhan, Haci Ahmet Kasapkara, Tahir Durmaz, Telat Keles, Cenk Sari, Serdal Bastug, Kemal Esref Erdogan, Nihal Akar Bayram, Emine Bilen, Murat Akcay, Engin Bozkurt
2015, 12(2): 100-106. doi: 10.11909/j.issn.1671-5411.2015.02.002
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive, emerging therapy in surgically high risk, or in-operable patients. Parameters used for risk classification have some deficiencies in the selection of patients. The objective of this study is to evaluate the impact of TAVI on carbohydrate antigen 125 (CA125) and N-Terminal pro Brain-type Natriuretic Peptide (NT-proBNP) as biomarkers that have been used frequently in recent years, and also the relationship of these biomarkers to prognosis. Methods & Results Transcatheter aortic valve implantation was practiced on 31 patients in this study. Then, CA125 and NT-proBNP levels studied in patients prior to and after the TAVI were evaluated. The patients were also grouped in accordance with their left ventricular ejection fraction (LVEF) and CA125 levels (LVEF ≥ 40% and 35 U/L). The TAVI operation was successfully performed in all patients. There was no in-hospital mortality and substantial improvement in functional capacity was detected at follow ups. In addition, a statistically significant decrease was detected in post-TAVI CA125 and NT-proBNP levels of all patients (CA125 83.8 ± 18.1 U/L vs. 64.3 ± 14.2 U/L, P = 0.008; NT-proBNP: 4633.6 ± 627.6 pg/mL vs. 2866.3 ± 536.8 pg/mL, P 35 U/L and LVEF Conclusions The results show that TAVI can be performed effectively and reliably in patients with high baseline levels of CA125 and NT-proBNP. These biomarkers are reduced substantially with TAVI, while high biomarker levels are associated with undesired events, and certainly, these biomarkers can be used for risk classifications in patient selection for TAVI.
Factors influencing the functional significance in intermediate coronary stenosis
Li-Jie SUN, Gui-Song WANG, Ming CUI, Li-Jun GUO, Yong-Zhen ZHANG, Fu-Chun ZHANG, Jie NIU, Jiang-Li HAN, Wei-Xian XU, Dan ZHU, Wei GAO
2015, 12(2): 107-112. doi: 10.11909/j.issn.1671-5411.2015.02.008
Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve (FFR) in interme-diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR Results Overall, FFR r = 0.372, P = 0.000) and the reference vessel diameters (RVD, r = 0.217, P = 0.002) were negatively correlated with percent area stenosis (AS, r = -0.251, P = 0.000) and percent diameter stenosis (DS, r = -0.210, P = 0.000). Age, MLD and the lesion location in different coronary arteries were the independent determinants of FFR Conclusions MLD can predict the functional significance of intermediate coro-nary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values.
A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study
Jiao-Jiao CHU, Xu-Jiao CHEN, Shan-Shan SHEN, Xue-Feng ZHANG, Ling-Yan CHEN, Jing-Mei ZHANG, Jing HE, Jun-Feng ZHAO
2015, 12(2): 113-118. doi: 10.11909/j.issn.1671-5411.2015.02.006
Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients (age 79.5 ± 6.7 years, male 63.8%) were recruited to the study. Comprehensive geriatric assessment (CGA), including measurements about activity of daily living (ADL), nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti performance oriented mobility assessment (POMA) and history of fall in the recent year. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index (BMI), and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile (P vs. T1, P vs. T2). Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale (P P Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effective interventions.
Associations between serum potassium and sodium levels and risk of hypertension: a community-based cohort study
Lu XI, Yong-Chen HAO, Jing LIU, Wei WANG, Miao WANG, Guo-Qi LI, Yue QI, Fan ZHAO, Wu-Xiang XIE, Yan LI, Jia-Yi SUN, Jun LIU, Lan-Ping QIN, Dong ZHAO
2015, 12(2): 119-126. doi: 10.11909/j.issn.1671-5411.2015.02.009
Objective Several studies have examined the relationships between dietary potassium and sodium and hypertension, but few have evaluated the association between serum potassium or sodium and risk of incident hypertension. We therefore investigated the associations between serum potassium and sodium and risk of incident hypertension in a Chinese community-based population. Methods A total of 839 normotensive individuals without cardiovascular disease from the Chinese Multi-Provincial Cohort Study who took part in the baseline examination in 2007–2008 and the follow-up survey in 2012–2013 were included in this study. Odds ratios (OR) and 95% confidence intervals (95%CI) for baseline serum potassium and sodium in relation to the risk of new-onset hypertension were evaluated using multivariate logistic regression models. Results During five years of follow-up, 218 (26.0%) individuals progressed to hypertension. Logistic regression adjusting for multiple confounders showed that every 1 mEq/L increment in baseline serum potassium level was associated with a 75% increased risk of hypertension (OR: 1.75; 95%CI: 1.01–3.04; P = 0.04). Compared with adults with serum potassium level of 4.20–4.79 mEq/L, adults with level ≥ 4.80 mEq/L had an 84% increased risk of hypertension (OR: 1.84; 95%CI: 1.14–2.96; P = 0.01). There was no significant association between serum sodium and risk of hypertension (OR: 0.96; 95%CI: 0.89–1.04; P = 0.33). Conclusions Baseline serum potassium level, but not baseline serum sodium level, was positively related to the risk of incident hypertension in the Chinese population.
G-protein beta 3 subunit polymorphisms and essential hypertension: a case-control association study in northern Han Chinese
Mei LI, Bei ZHANG, Chuang LI, Jie-Lin LIU, Li-Juan WANG, Ya LIU, Zuo-Guang WANG, Shao-Jun WEN
2015, 12(2): 127-134. doi: 10.11909/j.issn.1671-5411.2015.02.004
Objective To explore the association between the three polymorphisms [ C825T, C1429T and G(-350)A] of the gene encoding the G protein beta 3 subunit (GNB3) and hypertension by performing a case-control study in the northern Han Chinese population. Methods We recruited 731 hypertensive patients and 673 control subjects (the calculated power value was > 0.8). Genotyping was performed to identify C825T, C1429T and G(-350)A polymorphisms using the TaqMan assay. Comparisons of allelic and genotypic frequencies between cases and controls were made by using the chi-square test. Logistic regression analyses were performed to investigate the relationships between the three polymorphisms of GNB3 gene under different genetic models (additive, dominant and recessive models). Results The genotype distribution and allele frequencies of C825T, C1429T and G(-350)A polymorphisms did not differ significantly between hypertensive patients and control subjects, either when the full sample was assessed, or when the sample was stratified by gender. No significant association was observed between C825T, C1429T and G(-350)A polymorphisms and the risk of essential hypertension in any genetic model. Linkage disequilibrium was only detected between C825T and C1429T polymorphisms. Haplotype analyses observed that none of the three estimated haplotypes significantly increased the risk of hypertension. Conclusions Our study suggested that the GNB3 gene polymorphisms [C825T, C1429T and G(-350)A] were not significantly associated with essential hypertension in northern Han Chinese population.
Combination therapy reduces the incidence of no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction
Shan-Shan ZHOU, Feng TIAN, Yun-Dai CHEN, Jing WANG, Zhi-Jun SUN, Jun GUO, Qin-Hua JIN
2015, 12(2): 135-142. doi: 10.11909/j.issn.1671-5411.2015.02.003
Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute my-ocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction (AMI) undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow (no-flow score ≥ 10, by using a no-flow risk prediction model, n = 216) were randomly divided into a controlled group (n = 108) and a combination therapy group (n = 108). Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose (80 mg) atorvastatin pre-treatment, intracoronary administration of adenosine (140 μg/min per kilogram) during PCI procedure, platelet membrane glycoprotein Ⅱb/Ⅲa receptor antagonist (tirofiban, 10μg/kg bolus followed by 0.15 μg/kg per minute) and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events (MACE) were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group (35.2%, P P Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intracoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱb/Ⅲa receptor antagonist reduce the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.
Inappropriate use of digoxin in patients presenting with digoxin toxicity
Mustafa Adem Tatlisu, Kazim Serhan Ozcan, Baris Gungor, Ahmet Zengin, Mehmet Baran Karatas, Zekeriya Nurkalem
2015, 12(2): 143-146. doi: 10.11909/j.issn.1671-5411.2015.02.007
Background Digoxin remains widely used today despite its narrow therapeutic index and toxicity. The objective of this study was to investigate the percentage of inappropriate use of digoxin and long-term outcomes of elderly patients hospitalized for digoxin toxicity. Methods The study included 99 consecutive patients hospitalized for digoxin toxicity. The other study criteria for the inappropriate use of digoxin was regarded if participants having depressed left ventricular systolic function (ejection fraction Results Appropriate digoxin usage was confirmed in 33 of patients in spite of its narrow thera-peutic index. A total of 16 of 99 patients died, with a mean follow-up time of 22.1 ± 10.3 months. Conclusions Contrary to popular belief, the rate of inappropriate digoxin usage remains high. On account of its narrow therapeutic index and toxicity, digoxin should be used more carefully according to the current evidence and guidelines.
Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be?
Anil Ozen, Ertekin Utku Unal, Murat Songur, Sinan Sabit Kocabeyoglu, Onur Hanedan, Metin Yilmaz, Basak Soran Turkcan, Ferit Cicekcioglu, Sadi Kaplan, Cemal Levent Birincioglu
2015, 12(2): 147-152. doi: 10.11909/j.issn.1671-5411.2015.02.005
Objective Coronary artery bypass grafting (CABG) is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between January 2002 and December 2011, a total of 101 consecutive patients at an age of 80 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ± 2.27 years. Sixty-four (63.4%) were males and 37 (36.6%) were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit (ICU) stay, inotropic support, intra aortic balloon pulsation application, amount of erythrocyte transfusion and fresh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass (CPB) was found to be an independent predictor of mortality (OR: 1.18, 95% CI 1.01 ± 1.38, P = 0.034). The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.
Targeting histone deacetylases: perspectives for epigenetic-based therapy in cardio-cerebrovascular disease
Zi-Ying WANG, Wen QIN, Fan YI
2015, 12(2): 153-164. doi: 10.11909/j.issn.1671-5411.2015.02.010
Although the pathogenesis of cardio-cerebrovascular disease (CCVD) is multifactorial, an increasing number of experimental and clinical studies have highlighted the importance of histone deacetylase (HDAC)-mediated epigenetic processes in the development of car-dio-cerebrovascular injury. HDACs are a family of enzymes to balance the acetylation activities of histone acetyltransferases on chromatin remodeling and play essential roles in regulating gene transcription. To date, 18 mammalian HDACs are identified and grouped into four classes based on similarity to yeast orthologs. The zinc-dependent HDAC family currently consists of 11 members divided into three classes (class I, II, and IV) on the basis of structure, sequence homology, and domain organization. In comparison, class III HDACs (also known as the sirtuins) are composed of a family of NAD+-dependent protein-modifying enzymes related to the Sir2 gene. HDAC inhibitors are a group of compounds that block HDAC activities typically by binding to the zinc-containing catalytic domain of HDACs and have displayed anti-inflammatory and antifibrotic effects in the cardio-cerebrovascular system. In this review, we summarize the current knowledge about classifications, functions of HDACs and their roles and regulatory mechanisms in the cardio-cerebrovascular system. Pharmacological targeting of HDAC-mediated epigenetic processes may open new therapeutic avenues for the treatment of CCVD.
Drug therapy for heart failure in older patients—what do they want?
Donah Zachariah, Jacqueline Taylor, Nigel Rowell, Clare Spooner, Paul R Kalra
2015, 12(2): 165-173. doi: 10.11909/j.issn.1671-5411.2015.02.011
Chronic heart failure (CHF) is predominantly seen in older patients, and therefore real life medicine often requires the extrapolation of findings from trials conducted in much younger populations. Prescribing patterns and potential benefits in the elderly are heavily influenced by polypharmacy and co-morbid pathologies. Increasing longevity may become less relevant in the frail elderly, whereas improving quality of life (QoL) often becomes priority; the onus being on improving wellbeing, maintaining independence for longer, and delaying institutionalisation. Specific studies evaluating elderly patients with CHF are lacking and little is known regarding the tolerability and side-effect profile of evidence based drug therapies in this population. There has been recent interest on the impact of heart rate in patients with symptomatic CHF. Ivabradine, with selective heart rate lowering capabilities, is of benefit in patients with CHF and left ventricular systolic dysfunction in sinus rhythm, resulting in reduction of heart failure hospitalisation and cardiovascular death. This manuscript will focus on CHF and the older patient and will discuss the impact of heart rate, drug therapies and tolerability. It will also highlight the unmet need for specific studies that focus on patient-centred study end points rather than mortality targets that characterise most therapeutic trials. An on-going study evaluating the impact of ivabradine on QoL that presents a unique opportunity to evaluate the tolerability and impact of an established therapy on a wide range of real life, older patients with CHF will be discussed.
An overview of PCI in the very elderly
Vimalraj Bogana Shanmugam, Richard Harper, Ian Meredith, Yuvaraj Malaiapan, Peter J Psaltis
2015, 12(2): 174-184. doi: 10.11909/j.issn.1671-5411.2015.02.012
Cardiovascular disease, and in particular ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly (> 80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. Despite this, the very elderly are frequently under-represented in clinical revascularization trials and historically there has been a degree of physician reluctance in referring them for PCI procedures, with perceptions of disappointing outcomes, low success and high complication rates. Several issues have contributed to this, including the tendency for older patients with IHD to present late, with atypical symptoms or non-diagnostic ECGs, and reservations regarding their procedural risk-to-benefit ratio, due to shorter life expectancy, presence of comorbidities and increased bleeding risk from antiplatelet and anticoagulation medications. However, advances in PCI technology and techniques over the past decade have led to better outcomes and lower risk of complications and the existing body of evidence now indi-cates that the very elderly actually derive more relative benefit from PCI than younger populations. Importantly, this applies to all PCI set-tings: elective, urgent and emergency. This review discusses the role of PCI in the very elderly presenting with chronic stable IHD, non ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction. It also addresses the clinical challenges met when considering PCI in this cohort and the ongoing need for research and development to further improve outcomes in these challenging patients.
A very rare case of late diagnosis of cor triatriatum sinistrum
Ingrid Schusterova, Martin Czerny, Alexander Jurko, Jr., Milan Minarik
2015, 12(2): 185-186. doi: 10.11909/j.issn.1671-5411.2015.02.013
We presented a 73-year-old patient with a history of hospitalizations for heart failure as well as treatment for arterial hypertension and permanent atrial fibrillation and who was found to have cor triatriatum sinistrum in combination with bicuspid aortic valve. Patient refused surgical correction, but his condition improved on conservative therapy for heart failure and atrial fibrillation.
A new device for paravalvular leak closure
Ertugrul Ercan, Istemihan Tengiz, Ugur Turk, Ferhat Ozyurtlu, Emin Alioglu
2015, 12(2): 187-188. doi: 10.11909/j.issn.1671-5411.2015.02.014
Percutaneous closure of a prosthetic paravalvular leak (PVL) is a challenging procedure. Operators must use devices constructed for other applications. We present the use of a device which is specifically designed for PVL closure. To the best of our knowledge, there is no publication in MEDLINE reporting the use of the device.
Underpad weight to estimate urine output in adult patients with urinary in-continence
Benjamin T Galen
2015, 12(2): 189-190. doi: 10.11909/j.issn.1671-5411.2015.02.016