ISSN 1671-5411 CN 11-5329/R

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2016 Vol. 13, No. 12

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Aortic valve disease in the older adult
Neal Bhatia, Sukhdeep S Basra, Adam H Skolnick, Nanette K Wenger
2016, 13(12): 941-944. doi: 10.11909/j.issn.1671-5411.2016.12.004
Aortic stenosis, Elderly, Older; Valve disease
Chinese expert consensus on the management of hypertension in the very eld-erly
Jing LI, Yi-Xin HU, Wen WANG, Ning-Yuan FANG, Xin-Zheng LU, Lin PI, Mei-Lin LIU, Wei-Min LI, Yan-Fang LI, Peng QU, Qi HUA, Qing HE, Hai-Ying WU, Yuan-Ming ZHANG, Xiao-Ping CHEN, Lu-Yuan CHEN, Li FAN, Xing-Sheng ZHAO, Zhi-Ming ZHU, Yi-Nong JIANG, Yi-Fang GUO, Hong YUAN, Ping-Jin GAO, Xin-Juan XU, Jun CAI, Liang-Di XIE, Chinese Society of Geriatric Hypertension, Chinese Geriatrics Society
2016, 13(12): 945-953. doi: 10.11909/j.issn.1671-5411.2016.12.011
There is still a gap in the management of hypertension between octogenarians and routine population because of insufficient evidence. The success rate of treating hypertension in the elderly population is lower than those patients below the age of 80. We discussed the definition,characteristics and management for hypertension in the very elderly. The characteristics are isolated elevation in systolic BP, increased pulse pressure, abnormal circadian rhythm, large fluctuations of BP, multi risk factors coexisted, many concomitant accompanied, target organs severely damaged and so on. According to this consensus, general condition, co-existing disease, the risk of treatment and tolerance of medication should be considered in order to make a decision regarding the initiation treatment. During treatment, the effect from BP drop should be monitored and the tolerance should be considered for the purpose of titrating the medication. Life style modification is recommended for those patients who are not appropriate for medications. BP monitoring, regular follow up, and re-evaluation are necessary. BP level of initial treatment is {greater than or equal to}160/90 mmHg. And different target BP is recommended for patients with co-existing disease.
Management and risk factor control of coronary artery disease in elderly versus nonelderly: a multicenter registry
Arintaya Phrommintikul, Rungroj Krittayaphong, Wanwarang Wongcharoen, Smonporn Boon-yaratavej, Chaiyasith Wongvipaporn, Woraporn Tiyanon, Pakaphan Dinchuthai, Rapeephon Kun-jara-Na-Ayudhya, Pyatat Tatsanavivat, Piyamitr Sritara, the CORE investigators
2016, 13(12): 954-959. doi: 10.11909/j.issn.1671-5411.2016.12.002
Background Coronary artery disease (CAD) is a leading cause of death in elderly because aging is the important non-modifiable risk factors of atherosclerosis and also a predictor of poor outcomes. Underuse of guideline directed therapy may contribute to suboptimal risk factor control and worse outcomes in the elderly. We aimed to explore the management of CAD, risk factors control as well as goal attainment in elderly compared to nonelderly CAD patients. Methods The CORE-Thailand is an ongoing multicenter, prospective, observational registry of patients with high atherosclerotic risk in Thailand. The data of 4120 CAD patients enrolled in this cohort was analyzed comparing between the elderly (age ≥ 65 years) vs. nonelderly (age Results There were 2172 elderly and 1948 nonelderly patients. The elderly CAD patients had higher prevalence of hypertension, dyslipidemia, atrial fibrillation and chronic kidney disease. The proportion of patients who received coronary revascularization was not different between the elderly and nonelderly CAD patients. Antiplatelets were prescribed less in the elderly while statin was prescribed in the similar proportion. Goal attainments of risk factor control of glycemic control, low density lipoprotein cholesterol, and smoking cessation except the blood pressure goal were higher in the elderly CAD patients. Conclusions The CORE-Thailand registry showed the equity in the treatment of CAD between elderly and non-elderly. Elderly CAD patients had higher rate of goal attainment in risk factor control except blood pressure goal. The effects of goal attainment on cardiovascular outcomes will be demonstrated from ongoing cohort.
Association of non-synonymous variants in WIPF3 and LIPA genes with ab-dominal aortic aneurysm: an autopsy study
Yuko Maeda, Noriko Sato, Makiko Naka-Mieno, Seijiro Mori, Tomio Arai, Masashi Tanaka, Masaaki Muramatsu, Motoji Sawabe
2016, 13(12): 960-967. doi: 10.11909/j.issn.1671-5411.2016.12.003
Background Abdominal aortic aneurysm (AAA) is a multifactorial disease with strong genetic components. Various genetic loci have been associated with clinical AAA, but few studies have investigated pathological AAA, an intermediate phenotype of the disease. Methods We examined 2263 consecutive autopsies of older Japanese subjects from a study on geriatric diseases in Japanese individuals (The JG-SNP study). The presence of AAA was determined with a pathological diagnosis during autopsy. Single nucleotide variants (SNVs) associated with AAA were determined with an Illumina HumanExome Beadchip array. Logistic regression analyses were performed to determine genetic associations. Age, gender, and other risk factors of AAA were analyzed as covariates. Results 118 subjects with AAA and 2145 subjects without AAA were analyzed in a case-control setting. No variants reached significance after applying the Bonferroni correction (P ?6). The strongest associations were found with rs3750092 (p.E321G, OR: 0.36, 95% CI: 0.24–0.56, P = 6.09 ? 10?6), a variant in the WAS/WASL interacting protein family 3 (WIPF3), and with rs1051338 (p.T16P, OR: 2.50, 95% CI: 1.70–3.66, P = 2.79 ? 10?6) and rs2246942 (intronic, OR: 2.32, 95% CI: 1.58–3.41, P = 1.61 ? 10?5), variants in the lysosomal acid lipase A (LIPA). LIPA is essential for macrophage cholesterol metabolism. Immunohistological analyses of WIPF3 protein in AAA samples from three subjects revealed that WIPF3 was expressed in macrophages of atheromatous plaques. Conclusions This study suggests that WIPF3 and LIPA, both of which are expressed in the macrophages are involved in pathological AAA. These results should be regarded as hypothesis-generating; thus, replication study is warranted.
Xinfuli improves cardiac function, histopathological changes and attenuate cardiomyocyte apoptosis in rats with doxorubicin-induced cardiotoxicity
Pei-Pei LU, Jie MA, Xiao-Peng LIANG, Cai-Xia GUO, Yan-Kun YANG, Kun-Qi YANG, Qi-Ming SHEN, Li-Hong MA, Xian-Liang ZHOU
2016, 13(12): 968-972. doi: 10.11909/j.issn.1671-5411.2016.12.001
Background Xinfuli Granule (XG), a compound Chinese herbal medicine, has been effectively used in China for the treatment of heart failure for more than fifty years. This study aimed to investigate the effects and the underlying mechanisms of Xinfuli in rats with doxorubicin-induced cardiotoxicity. Methods Sprague–Dawley rats were treated with intraperitoneal injection of Doxorubicin (DOX, 2.5 mg/kg per week) for six weeks, and then randomly divided into four groups which received intragastrically administration of normal saline (control group) or different dosage of XG (0.675 g/kg per day, 1.35 g/kg per day, and 2.7g/kg per day, respectively) for six weeks. Transthoracic echocardiography was performed to evaluate the left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF) before and after the XG treatment and histopathologic changes were also examined. Myocardial cell apoptosis was detected by TUNEL staining. The expression of related genes and proteins were analyzed using immunohistochemical staining. Results Compared to those in the control group, rats in XG treated groups showed significantly improved cardiac function and milder cardiac histopathological changes, lower cardiomyocyte apoptosis index, higher expression of Bcl-2 and lower expression of Bax. Conclusions Administration of XG improves cardiac function and histopathological changes in rats with doxorubicin-induced cardiotoxicity. These effects are associated with inhibition of cardiomyocyte apoptosis, perhaps via regulation of Bcl-2 and Bax protein expression.
Validation of Veterans Specific Activity Questionnaire to assess exercise tolerance of Chinese elderly with coronary heart disease
Yan WANG, Jing-Jing SHI, Bo-Zhong WANG
2016, 13(12): 973-977. doi: 10.11909/j.issn.1671-5411.2016.12.005
Objective The Veterans Specific Activity Questionnaire (VSAQ) has been used to assess exercise tolerance. Nevertheless, there is no validated Chinese version. The aim of this study is to determine whether a questionnaire-based method using the Chinese version of VSAQ (the modified VSAQ) is a practical tool to assess exercise tolerance of Chinese elderly with coronary heart disease. Methods One hundred thirty consecutive elderly patients who were diagnosed with coronary heart disease (CHD) (mean age 68.9 ± 6.0 years) referred for treadmill exercise testing (TET) for clinical reasons were included in the study. They were asked to complete a questionnaire for clinical characteristics information on age, sex, history, exercise habits, medications, the original VSAQ and the modified VSAQ. We investigated the relationship between exercise tolerance in metabolic equivalents (METs) estimated by VSAQ and that obtained by TET. Results The METs by the original VSAQ and the modified VSAQ did not difference significantly (P = 0.528). The modified VSAQ scores were significantly correlated with the METs obtained by TET (r = 0.819, 95% CI: 0.753–0.873, P r = 0.804, 95% CI: 0.745–0.854, P Conclusions The Chinese version of the VSAQ confirmed its validity and equivalence to the original version, especially when evaluating individuals with coronary heart disease and older adults. The results showed that the VSAQ is a valuable tool to assess the exercise tolerance.
Free triiodothyronine in relation to coronary severity at different ages: Gensini score assessment in 4206 euthyroid patients
Bing-Yang ZHOU, Yuan-Lin GUO, Na-Qiong WU, Cheng-Gang ZHU, Ying GAO, Ping QING, Xiao-Lin LI, Yao WANG, Geng LIU, Qian DONG, Jian-Jun LI
2016, 13(12): 978-983. doi: 10.11909/j.issn.1671-5411.2016.12.006
Objective To study whether free triiodothyronine (FT3) within normal range has effects on the presence and severity of coronary artery disease (CAD) in different gender and age groups. Methods A total of 4206 euthyroid patients were consecutively enrolled and divided into CAD group (n = 3306) and non-CAD group (n = 900). All patients underwent coronary angiography (CAG). Gensini score (GS) was used to determine the severity of coronary artery stenosis. Severe CAD was defined as GS > 32 and mild CAD was defined as GS ≤ 32. Logistic regression analysis and linear regression analysis were conducted to determine the association of FT3 with CAD in patients with different gender and ages. Results Concentration of FT3 was lower in patients with CAD than that in angiography-normal control group (P ? 0.05). In addition, concentration of FT3 was lower in severe CAD than that in mild CAD. After adjusting for traditional cardiovascular risk factors and potential confounders, FT3 was negatively correlated with the presence of CAD, but not in the old patients (? 65 years old). Multivariable linear regression analysis showed that FT3 was negatively associated with GS in male and young patients with stable CAD, but not in the old patients. Conclusions Low FT3 within normal range was negatively associated with the presence and severity of CAD in young patients, but not in the old ones. Further studies are needed to confirm our findings.
Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions
Zhe TANG, Jing BAI, Shao-Ping SU, Pui-Wai LEE, Liang PENG, Tao ZHANG, Ting SUN, Jing-Guo NONG, Tian-De LI, Yu WANG
2016, 13(12): 984-991. doi: 10.11909/j.issn.1671-5411.2016.12.007
Objective To evaluate the factors affecting optimal stent expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy (RA) and a cutting balloon (CB). Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital (Beijing, China) were included in this study. They were divided into a rotational artherectomy combined with cutting balloon (RACB) group (46 patients treated with RA followed by CB angioplasty) and an RA group (46 patients treated with RA followed by plain balloon angioplasty). Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty (POBA) were demographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque preparation. Lumen diameter and lumen diameter stenosis (LDS) were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9% to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ± 9.4%) in the RA group (time × group, PP P r = 0.581, P Conclusions Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.
Cardiac drug therapy—considerations in the elderly
Mohamed Ayan, Naga Venkata Pothineni, Aisha Siraj, Jawahar L Mehta
2016, 13(12): 992-997. doi: 10.11909/j.issn.1671-5411.2016.12.008
Elderly individuals constitute a majority of patients encountered in current cardiovascular clinical practice. Management of these patients is a clinical challenge owing to a multitude of factors. Although medications such as statins have been shown to reduce cardiovascular mortality in the general population, evidence supporting the use of these drugs in patients greater than 75 years of age is sparse. Furthermore, aging associated changes in organ function and associated comorbidities influence the pharmacokinetics of multiple medications and can potentiate drug toxicity. In this article, we review the evidence behind the use of common cardiovascular medications in elderly patients and discuss pertinent clinical challenges.
Non-cardiogenic acute pulmonary edema in elderly patient with Dressler syndrome associated pulmonary embolism
Hui-Chun YU, Xiao-Bing MA, Zhen-Qing WANG, Hui-Jun XU, Ping WANG, Feng-Ping AN, Yu-Chuan HU, Guang-Bin CUI, Xu-Fang BAI, He LI
2016, 13(12): 998-1001. doi: 10.11909/j.issn.1671-5411.2016.12.009
Pulmonary embolism (PE) complicated with Dressler syndrome is an uncommon event, especially concomitant with non-cardiogenic acute pulmonary edema (NCAPE), which has rarely been described in the literature. The present report describes a classic presentation of this condition with review of its potential mechanisms and management approach. An 80-year-old female with PE presented with progressive exertional dyspnea, mild cyanosis and hypoxemia. Serum marker of acute thrombosis and right ventricular dysfunction were positive. Electrocardiographic changes indicative of RV strain. Echocardiography revealed the presence of right atrial and ventricular dilation, pulmonary hypertension and pericardial effusion. Chest computed tomography showed the interstitial pulmonary edema in bilateral lung field, pericardial and bilateral pleural effusion, and CT angiography revealed pulmonary embolism in the lower right pulmonary branches. She responded to oxygen, anticoagulation therapy and intravenous diuretics. But the outcome still was adverse and died in her home two months after discharge. The present case suggested a very poor prognosis of NCAPE induced by PE, thus identification of potential risk factors for development of thromboembolic complications and risk stratification in high risk population are required necessarily.
The importance of being “not transplantable”
Rossana Taravella, Marco Caruso, Massimo Benedetto, Renato Ciofalo, Giuliana Pace, Salvatore Asciutto, Salvatore Novo, Giuseppe Cirrincione
2016, 13(12): 1002-1004. doi: 10.11909/j.issn.1671-5411.2016.12.010
MitraClip therapy for Mitral Regurgitation(MR) in advanced-endstage heart failure(HF),could open a final bridge to improve symptoms and quality of life in \"not transplantable\" patients. We describe a homeless patient with NYHA class III HF, not elegible to heart transplantation for poor socio-economic status,and severe functional MR,treated with MitraClip. The patient was not suitable for conventional mitral valve repair because of high surgical risk and advanced HF (The STS mortality morbidity score=76%; EUROSCORE II=9,7%). Severe MR was confirmed at TEE preoperative evaluation of patient in which severe LV systolic dysfunction, diastolic dysfunction, severe right ventricle dysfunction, moderate tricuspid regurgitation and post-capillary pulmonary hypertension were detected. After 2 MitraClips implantation, TEE documented effective device position in relation to the main regurgitant jet, a MR grade reduction to 2 , with uneventful recovery. A gradual hemodynamic and general improvement was observed at three-month follow-up echocardiography documenting PAPs reduction and LVEF improvement. Beside, the patient showed HF symptoms reduction in NYHA class I-II. Management of functional MR in end-stage HF is an hard challenge, in addiction to the limited patient group feasibility and long-waiting list of heart transplantation. In the setting of this difficult current real-world experience, percutaneous tecnique was able to improve general conditions, quality of life and survival of our referred patient.