2017 Vol. 14, No. 11
Heart rate variability (HRV) refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.
Objectives The aim of this study was to develop a clinical risk model that is predictive of in-hospital mortality in elderly patients hospitalized with acute heart failure (AHF). Methods 2486 patients who were 60 years and older from intensive care units of Cardiology Department in the hospital were analyzed. Independent risk factors for in-hospital mortality were obtained by binary logistic regression and then used to establish the risk prediction score system (RPSS). The area under the curve (AUC) of receiver operator characteristic and C-statistic test were adopted to assess the performance of RPSS and to compare with previous get with the guidelines–heart failure (GWTG-HF). Results By binary logistic regression analysis, heart rate (OR: 1.043, 95% CI: 1.030–1.057, P P P P P vs. 0.818, P = 0.016). Conclusions Our risk prediction model, RPSS, provided a good prediction for in-hospital mortality in elderly patients with AHF.
Objective The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world setting. Methods We retrospectively analyzed data from an international, multi-center registry between 2003 and 2014 (n = 15,401). Patients with ACS and receiving OAC after PCI were screened. The composite primary endpoint was 1-year all-cause death, re-infarction, or severe bleeding. Results The final analysis enrolled 642 patients including 62 patients (9.7%) with OAC and clopidogrel (dual therapy), and 580 patients (90.3%) with the combination of aspirin, OAC and clopidogrel (triple therapy). Patients on triple therapy were more often female and were more likely to have comorbidities. There was no significant difference regarding the primary end point between dual therapy with triple therapy patients [17.74% vs. 17.24%; unadjusted hazard ratio (HR): 1.035; 95% confidence interval (CI): 0.556–1.929; adjusted HR: 1.026; 95% CI: 0.544–1.937]. However, the re-infarction rate was significantly higher in dual therapy than triple therapy patients (14.52% vs. 5.34%; unadjusted HR: 2.807; 95% CI: 1.329–5.928; adjusted HR: 2.333; 95% CI: 1.078–5.047). In addition, there was no difference between two regimes in all-cause death and severe bleeding. Conclusions In real-life patients with ACS following PCI and with an indication of OAC, triple therapy was not associated with an increased rate of adverse outcomes compared to dual therapy. Moreover, it decreased risk of re-infarction and did not increase risk of severe bleeding.
Objective to evaluate the effects of environmental factors and microRNAs (miRNAs) (miR-126, miR-143, and miR-145) on the risk of coronary heart disease (CHD). Methods A frequency-matched case-control study (450 patients, 450 controls) was conducted from April 2014 to December 2016 in Fuzhou City, China. Environmental factors were investigated using a self-administered questionnaire, and the expression levels of miR-126, miR-143, and miR-145 were determined by quantitative real-time Polymerase Chain Reaction (PCR) in peripheral blood mononuclear cells. Unconditional logistic regression models were used for statistical evaluation. Results Alcohol consumption, high-salt diets, high-intensity work, and lack of physical activity were significantly associated with increased CHD risk, whereas light diet was significantly associated with decreased risk. MiR-126, miR-143, and miR-145 were highly expressed in the CHD group compared with the control group. After adjustment for other environmental factors, unconditional logistic regression results revealed that miR-126, miR-143, and depression were the independent risk factors of CHD, and light diet was the independent protective factor of CHD. Conclusions Our data suggest that a family history of CHD, anxiety, and alcohol consumption was significantly associated with increased CHD risk, whereas light diet was significantly associated with decreased risk. Furthermore, miR-126 and miR-143 in combination with several risk factors, could play a joint role in the development of CHD. Therefore, it is necessary to manage patients with CHD in all directions and multiple level.
Epidemiological studies and animal experiments have consistently demonstrated cardiovascular protection by high-density lipo-protein (HDL). Findings from a growing number of studies further indicate that sphingosine-1-phosphate (S1P) mediates many of the beneficial effects of HDL on the cardiovascular system, including vasodilatation, angiogenesis, maintenance of endothelial barrier function, and protec?tion against atherosclerosis and ischemia/reperfusion injury. In this review, we summarize the most recent litera-ture investigating the effects of HDL-S1P on cardiovascular health and highlight potential opportunities for clinical translation of these findings.
Depression and cardiovascular disease (CVD) are both highly prevalent disorders, and some evidence shows that there is a ‘vi-cious cycle’ linking major depression and CVD. There is also growing evidence that immune abnormalities underpin the common pathophysiology of both CVD and major depression. The abnormalities include the following: abnormal levels of inflammatory mark-ers, such as interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α) and interleukin-12 (IL-12); increased acute phase proteins, such as C-reactive protein, fibrinogen and haptoglobin; and abnormal complement factors. The findings show that ma-jor depression and CVD patients have greater immune abnormalities, which may increase depressive symptoms and cardiovascular pathological changes, and that there may be a bidirectional relationship, therefore more prospective studies are needed to draw conclu-sions.
Dear Editor, I attach a very interesting case of TAVI endocarditis.i would be grateful if we could incorporate it to the following Special Issue (Guest Editors :Koniari Ioanna and Hahalis George) as letter to the Editor.
Cardiac amyloidoses (CA), a disease caused by the precipitation of amyloid in myocardial extracellular matrix, is difficult to diagnose due to lack of specificity of the clinical manifestations, and can be easily misdiagnosed. The patient was a 59-year-old man showed symptoms of double eyelid swelling and chest tightness without obvious causes. Electrocardiograph (ECG) for many times reveal low voltage in limb leads and poor progression of R waves in V1-V3. Furthermore, the levels of brain natriuretic peptide (BNP) and cardiac Troponin I (cTnI) are increased. The results of echocardiography suggested symmetric thickening of the left ventricle (IVS: 12mm, LVPW: 12mm), granular echoes in myocardium, left ventricular diastolic dysfunction (level III) (EF57%). Urine K light chain<0.1mg/l (0-7.1mg/L), urine λ light chain: 30.39mg/l increment (0-3.9 mg/L). The bone marrow results suggested no significant plasma cell dyscrasia. Since the gold standard for CA diagnosis is histopathological examination, skin and muscle biopsies of both eyelids were completely examined, hematoxylin and eosin (HE) and Congo red staining, suggesting positive result of Congo red staining. The results of polarized light examination suggested the presence of birefringence of apple green. Immunofixation electrophoresis was carried out for the serum, Bence-Jones protein electrophoresis was carried out for the urine sample, and results suggested M-proteinemia of LAM. The initial symptom of this case was manifested in the eyelid, after excluding orbital disease, coronary heart disease, lung disease and hypertrophic cardiomyopathy, the patient was diagnosed as cardiac amyloidosis through eyelid biopsy, fully demonstrating that “the eyes are the window to the heart”.
We read the article entitled ‘Depression is associated with increased C-reactive protein levels in patients with heart failure and hyperuricemia’. In this article WANG, et al. reported that serum hs-CRP may be an independent marker for severity of depression in heart failure patients with hyperuricemia. The authors suggested that the relationship between the role of inflammation in the pathogenesis of depression and heart failure may help to devise new strategies. However, we have some suggestions about this study: there was no control group and plasma NT-proBNP is not investigated in study group.