ISSN 1671-5411 CN 11-5329/R

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2018 Vol. 15, No. 8

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Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery
Matteo Briguglio, Luigi Gianturco, Daniele Stella, Chiara Colombo, Marika Bonadies, Oscar Sala, Mauro Anselmi, Giuseppe Banfi, Maurizio Turiel
2018, 15(8): 519-522. doi: 10.11909/j.issn.1671-5411.2018.08.005
Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the normalization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months calcifediol supplementation with a starting dose at first post-operative day of 50 μg/die in liquid preparation. Down-titration to 20 μg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of calcifediol supplementation were associated with a significant improvement of both LVEF (+ 3.94%; 95% CI: -4.0789 - -0.8232; P P Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.
Five-year major clinical outcomes between first-generation and second-generation drug-eluting stents in acute myocardial infarction patients underwent percutaneous coronary intervention
Yong Hoon Kim, Ae-Young Her, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Ju Yeol Baek, Woong Gil Choi, Tae Soo Kang, Ji Hoon Ahn, Sang-Ho Park, Ahmed Mashaly, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
2018, 15(8): 523-533. doi: 10.11909/j.issn.1671-5411.2018.08.006
Background There were limited data comparing the major clinical outcomes between first-generation (1G)-drug eluting stents (DES) and second-generation (2G)-DES in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) during very long follow-up periods. We thought to investigate the comparative efficacy and safety of 2G-DES compared with 1G-DES in AMI patients during 5-year follow-up periods. Methods A total of 1016 eligible AMI patients who underwent PCI with 1G-DES [paclitaxel- , sirolimus-, 1G-zotarolimus-eluting stent (endeavor? or endeavor?), n = 554] or 2G-DES [2G-zotarolimus (endeavor resolute?)- or everolimus-eluting stent, n = 462] were enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR) and the secondary endpoint was stent thrombosis (ST) at 5 years. Results Two propensity score-ma-tched (PSM) groups (232 pairs, n = 464, C-statistic = 0.802) were generated. During the 5-year follow-up period, the cumulative incidence of TLR [hazard ratio (HR): 3.133; 95% confidence interval (CI): 1.539–6.376; P = 0.002], TVR (HR: 3.144; 95% CI: 1.596–6.192; P = 0.001) and total revascularization rate (HR: 1.874; 95% CI: 1.086–3.140; P = 0.023) were significantly higher in 1G-DES compared with 2G-DES after PSM. However, the incidence of total death, non-fatal MI and ST were similar between the two groups. Conclusions In this single-center and all-comers registry, 2G-DES’s superiorities for TLR, TVR and total revascularization in AMI patients suggested during 5-year clinical follow-up periods.
Subclinical hypothyroidism is associated with lipid-rich plaques in patients with coronary artery disease as assessed by optical coherence tomography
Xiao-Qing CAI, Feng TIAN, Tian-Wen HAN, Dong-Kai SHAN, Yang LIU, Wei-Jun YIN, Jing Jing, Qiang Xu, Yun-Dai CHEN
2018, 15(8): 534-539. doi: 10.11909/j.issn.1671-5411.2018.08.007
Background Subclinical hypothyroidism (SCH) has recently been acknowledged as an unconventional risk factor for coronary artery disease (CAD) and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group (patients, n = 26; plaques, n = 35) and a non-SCH group (patients, n = 52; plaques, n = 66). They were divided 1: 2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography (OCT) imaging was performed on all patients, and images were analyzed by two independent investigators. Lipid-rich plaques (LRP), the precursor of vulnerable plaques, were defined as having more than one quadrant occupied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The presence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group (54% vs. 30.3%, P = 0.037). That was the case as well for the maximum lipid arcs value (181.5° ± 61.6°vs. 142.1° ± 35.9°, P = 0.046). While thin-cap fibroatheroma (TCFA) was detected, no difference was identified between the two groups in either TCFA ratio (20% vs. 16.7%, P = 0.579) or fibrous cap thickness (57.5 ± 14.0 vs. 63.5 ± 10.7 μm, P = 0.319). Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. Conclusions Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.
Natriuretic peptide family as diagnostic/prognostic biomarker and treatment modality in management of adult and geriatric patients with heart failure:remaining issues and challenges
Zhen–Lu ZHANG, Ran LI, Fei–Yan YANG, Lei XI
2018, 15(8): 540-546. doi: 10.11909/j.issn.1671-5411.2018.08.008
B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), the key members of natriuretic peptide family have been recommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure (HF) according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particularly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on their use in geriatric cardiology settings. We have focused on several remaining issues and challenges regarding the clinical utilization of BNP and NT-proBNP, which include: (1) Different prevalence and diagnostic/prognostic values of BNP isoforms; (2) methodological issues on detection of BNP; (3) glycosylation of proBNP and its effect on biomarker testing; (4) specificity and comparability of BNP/NT-proBNP resulted from different testing platforms; (5) new development of natriuretic peptides as HF treatment modality; (6) BNP paradox in HF; and (7) special considerations of using BNP/NT-proBNP in elderly HF patients. These practical discussions on BNP/NT-proBNP may be instrumental for the healthcare providers in critically interpreting laboratory results and effective management of the HF patients.
Normalization of plasma growth hormone alleviated malignant ventricular tachycardia in acromegaly
Zhi-Hao LIU, Kang LI, Yan-Sheng DING, Jian-Xing QIU, Steven Siyao Meng, Mohetaboer Momin, Sheng-Cong LIU, Tie-Ci YI, Jian-Ping LI
2018, 15(8): 547-550. doi: 10.11909/j.issn.1671-5411.2018.08.003
Patent foramen ovale in an old patient with ischemic stroke following carotid surgery
Elpidio Santillo, Monica Migale, Luciano Marini, Raffaele Antonelli-Incalzi
2018, 15(8): 551-553. doi: 10.11909/j.issn.1671-5411.2018.08.001
Rare combination of dilated cardiomyopathy and ankylosing spondylitis in a family
Yun-Li XING, Ying SUN, Qing MA, Yu LU, Ying SHAO, Wei HUANG, Dai ZHANG, Fu-Sheng GU, Hong-Wei LI
2018, 15(8): 554-556. doi: 10.11909/j.issn.1671-5411.2018.08.002
Physical activity in older people with cardiac co-morbidities
Jun–Ming Liew, Shyh Poh Teo
2018, 15(8): 557-558. doi: 10.11909/j.issn.1671-5411.2018.08.004