2017 Vol. 14, No. 8
The coronary artery calcification score and pericardial fat volume have recently been reported to be strongly associated with the severity and presence of coronary atherosclerosis. However, no studies have explored the outcome of phased progression of athero-sclerosis by non-contrast computed tomography in asymptomatic people in China. The population-based cohort study in outcome of phased progression of atherosclerosis in China (PERSUADE), an observational, longitudinal and prospective cohort study in a target population of healthy subjects based in Jidong Oilfield (China), prospectively analyzes the outcome of phased progression of ather-osclerosis by non-contrast computed tomography in healthy population. The results of this study are expected to be of value for uti-lizing noninvasive imaging combine with traditional cardiovascular risk factors to create a risk stratification and find pertinent bi-omarkers associated with the outcome of phased progression of atherosclerosis in healthy people, thereby could help to establish a more personalized treatment of clinical practice.
Objectives The left atrial appendage (LAA) is known to play a reservoir role in left atrial (LA) hemodynamics. The physiologic consequences of its percutaneous occlusion have not been evaluated. We sought to evaluate the effect of percutaneous LA appendage closure (LAAC) on LA remodelling and cardiac hemodynamics. Methods: All patients referred for LAAC in our institution were enrolled. Cardiac computed tomography for LA volume measurement and transthoracic echocardiography (TTE) for left ventricular diastolic function and filling pressure assessment were performed at baseline and 3 months after closure. Results: Sixty-three patients (mean age 73 ? 9 years) underwent successful LAAC and remain clinically stable at 3 months without change in medical treatment except the introduction of an antiplatelet therapy. Mean LA volume, excluding the LAA did not change between baseline and follow-up (145 55 mL and 144 50 mL, p=0.30). Among diastolic function echographic parameters, the E/E’ ratio increased (7.9?2.1 vs 9.1?3.6; p=0,038), suggesting a trend toward an elevation of LV filling pressure. Conclusions: In this preliminary study, we showed no early significant LA remodelling after LAA occlusion in terms of volume change, but a trend toward an increase of LV filling pressure. Our results suggest potential changes in cardiac hemodynamics after LAA closure, suggesting to be cautious when performing this procedure in patients with heart failure. Additional studies with longer follow-up and invasive evaluations should be performed to better investigate this potential issue.
Background Telehealth interventions (THI) were associated with lower levels of cardiovascular risk factors in adults, whereas the effect of THI on cardiovascular disease (CVD) still remains controversial. A meta-analysis was conducted to summarize the evidence from randomized controlled trials (RCT) which investigated potential impact of THI on the incidence of CVD in patients with or without prior CVD. Methods PubMed, EmBase, and the Cochrane Library were searched to identify RCTs to fit our analysis through December 2016. Relative risk (RR) with its 95% confidence interval (CI) was used to measure the effect of THI using a random-effect model. Sensitivity analysis, subgroup analysis, heterogeneity tests, and tests for publication bias were also conducted. Results Eight RCTs were included and with a total of 1635 individuals. The summarized results indicated that participants who received THI showed a significant reduction of the CVD incidence as compared with usual care (RR: 0.59; 95% CI: 0.47–0.74; P P P = 0.977). Sensitivity analysis suggested that the intervention effect persisted and the conclusion was not changed. Subgroup analysis indicated mean age, study quality might play an important role on the risk of CVD. Conclusions The findings of this study indicated THI could reduce the recurrence of CVD. Further large-scale trials are needed to verify the effect of THI on CVD in healthy individuals.
Background The vasovagal reflex syndrome (VVRS) is common in the patients undergoing percutaneous coronary intervention (PCI). However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. Methods From the hospital electronic medical database, we identified 3550 patients who received PCI (78.0% males, mean age 60 years) in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic (ROC) analysis were performed. Results The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation (all P P P P Conclusion The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be involved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.
Background Inhibition of aging of vascular endothelial cells (VECs) may delay aging and prolong life. The goal of this study was to prepare anti-CD31 monoclonal antibody conjugated PEG-modified liposomes containing the AU-rich region connecting factor 1 (AUF1) gene (CD31-PILs-AUF1) and to explore the effects of targeting CD31-PILs-AUF1 to aging VECs. Methods The mean particle sizes of various PEGylated immunoliposomes (PILs) were measured using a Zetasizer Nano ZS. Gel retardation assay was used to confirm whether PILs had encapsulated the AUF1 plasmid successfully. Fluorescence microscopy and flow cytometry were used to quantify binding of CD31-PILs-AUF1 to target cells. Flow cytometry was also used to analyze the cell cycles of aging bEnd3 cells treated with CD31-PILs-AUF1. We also developed an aging mouse model by treating mice with D-galactose. Enzyme-linked immunosorbent assay (ELISA) was used to evaluate the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). The malondialdehyde (MDA) and the superoxide dismutase (SOD) levels were detected by commercial kits. Hematoxylin-eosin (HE) staining was used to determine whether treatment with CD31-PILs-AUF1 was toxic to the mice. Results CD31-PILs-AUF1 specifically could targeted bEnd3 VECs and increased the percentage of cells in the S and G2/M phases of aging bEnd3 cells. ELISA showed that content of the IL-6 and TNF-α decreased in CD31-PILs-AUF1 group. The level of SOD increased, whereas MDA decreased in the CD31-PILs-AUF1 group. Additionally, CD31-PILs-AUF1 was not toxic to the mice. Conclusion CD31-PILs-AUF1 targets VECs and may delay their senescence.
Objective There are still a high proportion of patients with ST-segment elevation myocardial infarction (STEMI) missing out early reperfusion even in the primary percutaneous coronary intervention (PCI) era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones is controversial. Methods We investigated all STEMI patients who underwent delayed PCI (2–28 days after STEMI) during 2007–2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was major adverse cardiovascular events (MACEs). Results This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time (early group, 55.9%; median group, 35.4%; late group, 8.7%). During 1-year follow-up, MACEs occurred in 319 patients. The prevalence of MACE were respectively 7.0%, 5.8% and 6.3% (P = 0.272) among three groups. The median group had less recurrent myocardial infarction (P = 0.049) than late group and less repeat revascularization (P = 0.008) than early group in pairwise comparison. We depicted the incidence of MACE by delayed time as a quadratic curve and found the bottom appeared at Day 13–14. Conclusions The time for delayed PCI varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.
The twiddler syndrome is an uncommon cause of pacemaker malfunction, in which twisting or rotating of the device in its pocket results in lead retraction or coiling and subsequent malfunction of an implanted devices such as a pacemaker, an implantable cardioverter– de?brillator (ICD), cardiac resynchronization therapy (CRT)[1,2] This report describes a rare case of twiddler syndrome after implantation of a ICD that manifested with pectoral muscular twitching.
Cardiac tumors are exceedingly rare. While some may go undetected for years, others may manifest as embolic phenomena, acute coronary syndrome, or symptomatic heart failure. Advances in cardiac imaging have increased the detection rate of these tumors, facilitating early diagnosis and treatment. Here we present the unique finding of a left ventricular papillary fibroelastoma manifesting as peripheral arterial disease due to systemic embolization. We will briefly discuss the most common types of cardiac tumors, their incidence, manifestations and treatment. In the conclusion of our manuscript, we highlight the critical role of cardiac imaging in early diagnosis of these tumors
We describe a rare case of huge aneurysm of saphenous vein graft (SVG) causing mechanical compression which developed 20 years after coronary artery bypass graft. The present case emphasize the importance of the multimodality imaging to diagnose a thrombosed SVG aneurysm with hemodynamic derangement and follow up after successful treatment with surgical resection.
Tako-tsubo cardiomyopathy(TTC) is an acute、 reversibile disease，which is always undiagnosised or misdiagnosised. TTC is characterized by a local and transient left ventricular wall motion abnormality. We introduce the case of 81-year old female patient with colorectal cancer, who suffered TTC after the radical operation. She also had coronary artery disease(CAD) and had a percutaneous coronary intervention(PCI) history. Surgery is often regarded as an independent risk factor of TTC. Little is known about the association of TTC between CAD, and it is also a challenge to distinguish them.