ISSN 1671-5411 CN 11-5329/R

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2019 Vol. 16, No. 11

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Predictive clinical features of cardioembolic infarction in patients aged 85 years and older
Ana Maria Carbajo-Garcia, Jonatan Cortes, Adria Arboix, Joan Massons, Laura Diez, Enric Verges, Jordi Arboix-Alio, Luis Garcia-Eroles
2019, 16(11): 793-799. doi: 10.11909/j.issn.1671-5411.2019.11.008
Objective To assess predictive clinical factors of cardioembolic infarction in very old patients (85 years of age and older). Methods Prospective hospital-based stroke registry ("The Sagrat Cor Hospital of Barcelona Stroke Registry") is an acute-care teaching hospital in Barcelona, Catalonia, Spain. From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period, 639 were younger than 85 years of age and 317 were 85 years or older (mean age 88.9 years). Demographics, clinical characteristics, risk factors and early outcome were compared. Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses. Results In a logistic regression model based on demographics, risk factors, clinical features and complications, female gender (odds ratio [OR] = 1.74, 95% confidence interval [CI]: 1.27–2.39), heart failure (OR = 2.27, 95% CI: 1.46–3.56), altered consciousness (OR = 1.76, 95% CI: 1.28–2.42), and infectious complications (OR = 2.01, 95% CI: 1.39–2.91) were predictors of cardioembolic stroke in the oldest age group. By contrast, heavy smoking, heart valve disease, hypertension, headache, early seizures, sensory deficit, and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group. Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.
Longitudinal changes in cardiac function in the very elderly: the Jerusalem longitudinal cohort study
David Leibowitz, Irit Stessman-Lande, Hend Sliman, Jeremy M Jacobs, Jochanan Stessman, Dan Gilon
2019, 16(11): 800-805. doi: 10.11909/j.issn.1671-5411.2019.11.004
Background People over the age of 85 are a rapidly growing age group with a high incidence of congestive heart failure (CHF), in particular heart failure with preserved ejection fraction (HFpEF). The diagnosis of CHF is challenging and longitudinal data assessing cardiac structure and function are necessary to distinguish physiologic from pathologic cardiac aging. The objective of the study was to determine longitudinal changes in cardiac struture and function from ages 85 to 94 years using home echocardiography. Methods Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Sixty three members of the initial cohort (32F, 31M) who underwent home echocardiography at age 85 were the subjects of the current study and underwent repeat home 2-D and Doppler echocardiographic assessment at age 94. Results There were no significant longitudinal changes in left ventricular mass index (LVMI), however LV end-diastolic volume significantly decreased from 113.4 ± 30 to 103.6 ± 35.5 mL (P 2 (P P 2, P Conclusions This study demonstrated preserved EF with decreased longitudinal systolic function and diastolic function without significant change in LV mass. Changes in LV function in the very elderly may be independent of changes in LV geometry.
Major bleeding events in octagenarians associated with drug interactions between dabigatran and P-gp inhibitors
Marjorie Bernier, Sarah-Line Lancrerot, Fanny Rocher, Elise K Van-Obberghen, Pierre Olivier, Thi-baud Lavrut, Nadège Parassol-Girard, Milou-Daniel Drici
2019, 16(11): 806-811. doi: 10.11909/j.issn.1671-5411.2019.11.002
Background The direct oral anticoagulant dabigatran does not require any routine therapeutic drug monitoring. Yet, concerns about possible drug interactions susceptible to increase its inherent bleeding risk, especially in very elderly patients, have been raised recently. The aim of our study was to evaluate to what extent the co-prescription of P-gp inhibitors with dabigatran may increase its plasma levels and lead to bleeding complications, in usual conditions of care of the very elderly. Methods Fifty-eight patients over 85 years-old with non valvular atrial fibrillation receiving dabigatran were included in a prospective cohort. Prescriptions were screened for the presence of P-gp inhibitors (Group A) or not (Group B). Results Patients from Group A had increased dabigatran mean plasma concentrations as compared with patients from Group B (A vs. B: 182.2 ± 147.3 vs. 93.7 ± 64.9 ng/mL). One third of the patients from Group A had dabigatran concentrations that were deemed “out of range” versus none in Group B (P = 0.05). This was associated with more frequent bleeding complications in Group A (A: 30.4%, B: 8.6%, P = 0.04). Conclusion In our cohort of very elderly patients, at least, the co-prescription of dabigatran with P-gp inhibitors in usual conditions of care resulted in higher dabigatran plasma concentrations and more frequent bleeding occurrences.
Association between big endothelin-1 and CHADS2/CHA2DS2-VASc scores in non-valvular atrial fibrillation
Li-Hui ZHENG, Shang-Yu LIU, Feng HU, Er-Peng Liang, Ling-Min WU, Hong-Lei WANG, Ammar M Killu, Yan YAO
2019, 16(11): 812-817. doi: 10.11909/j.issn.1671-5411.2019.11.003
Background Endothelial function, as measured by big endothelin-1 (ET-1), has been demonstrated to be useful in predicting adverse long-term events in patients with cardiovascular disease. Nevertheless, there are little data about the association between big ET-1 and thromboembolism risk in atrial fibrillation (AF). We aimed to investigate the relationship between big ET-1 and CHADS2/CHA2DS2-VASc scores used for evaluating thromboembolic risk in patients with non-valvular AF. Methods The study population consisted of 238 consecutive AF patients (67.6% with paroxysmal AF and 32.4% with persistent AF). The patients were divided into two groups (high- or low-intermediate risk group) based on CHADS2 and CHA2DS2-VASc scores (score ≥2 or 2/CHA2DS2-VASc scores were compared between groups. The association between big ET-1 levels and CHADS2/CHA2DS2-VASc score was assessed. Multivariate logistic regression analysis was performed to identify independent predictors of CHADS2/CHA2DS2-VASc scores. Results The high CHADS2/CHA2DS2-VASc score group had older age, higher big ET-1 levels, and enlarged left atrial diameter than the low CHADS2/CHA2DS2-VASc score group (P 2/CHA2DS2-VASc scores [odds ratio (OR) = 2.545 and OR = 3.816; both P Conclusions Our study indicates that in non-valvular AF, big ET-1 was significantly correlated with CHADS2/CHA2DS2-VASc scores and an independent predictor of high CHADS2/CHA2DS2-VASc scores. Big ET-1 may serve as a useful marker for risk stratification in this setting.
Circulating lncRNA MHRT predicts survival of patients with chronic heart failure
2019, 16(11): 818-821. doi: 10.11909/j.issn.1671-5411.2019.11.006
Background It has been reported that lncRNA myosin heavy-chain-associated RNA transcripts (MHRT) can inhibit the apoptosis of cardiomyocytes. It is one of the major pathological changes leading to chronic heart failure. Methods The expression level of lncRNA MHRT was assessed by qRT-PCR. Diagnostic values of lncRNA MHRT for chronic heart failure were analyzed by ROC curve analysis. Cell apoptosis was detected by cell apoptosis assay. Results The results demonstrated that expression of lncRNA MHRT in plasma was down-regulated in patients with chronic heart failure compared to that in healthy people. Down-regulation of lncRNA MHRT distinguished chronic heart failure from healthy people. Over-expression of lncRNA MHRT inhibited the apoptosis of human cardiomyocyte cell line AC16 after H2O2 treatment. Follow-up study showed that chronic heart failure patients with lower expression levels of lncRNA MHRT had worse survival conditions compared to patients with higher expression levels of lncRNA MHRT. Conclusion We concluded that circulating lncRNA MHRT might serve as a diagnostic and prognostic marker for chronic heart failure treatment.
Endogenous hydrogen sulfide and ERK1/2-STAT3 signaling pathway may participate in the association between homocysteine and hypertension
Lin SHI, Xiao-Yun LIU, Zhi-Gang HUANG, Zhi-Yi MA, Yang XI, Lu-Yan WANG, Ning-Ling SUN
2019, 16(11): 822-834. doi: 10.11909/j.issn.1671-5411.2019.11.007
Background Homocysteine (Hcy) is a risk factor for hypertension, although the mechanisms are poorly understood. Methods We first explored the relationship between Hcy levels and blood pressure (BP) by analyzing the clinical data of primary hypertensive patients admitted to our hospital. Secondly, we explored a rat model to study the effect of Hcy on blood pressure and the role of H2S. An hyperhomocysteinemia (HHcy) rat model was induced to explore the effect of Hcy on blood pressure and the possible mechanism. We carried out tissue histology, extraction and examination of RNA and protein. Finally, we conducted cell experiments to determine a likely mechanism through renin-angiotensin-aldosterone system (RAAS) and extracellular signal-regulated kinase 1/2 (ERK1/2) signaling pathway. Results In primary hypertensive inpatients with HHcy, blood pressure was significantly higher as compared with inpatient counterparts lacking HHcy. In the rat model, blood pressure of the Wistar rats was significantly increased with increases in serum Hcy levels and decreased after folate treatment. Angiotensin converting enzyme 1 (ACE1) expression in the Wistar Hcy group was enhanced comparing to controls, but was decreased in the Wistar folate group. Angiotensin II receptor type 1 (AGTR1) levels in the kidney tissue increased in the Wistar folate group. Both serum H2S and kidney cystathionine γ-lyase decreased with elevated levels of serum Hcy. In vitro, increased concentrations and treatment times for Hcy were associated with increased expression of collagen type 1 and AGTR1. This dose and time dependent response was also observed for p-STAT3 and p-ERK1/2 expression. Conclusion Endogenous H2S might mediate the process of altered blood pressure in response to changes in serum Hcy levels, in a process that is partly dependent on activated RAAS and ERK1/2- STAT3 signaling pathway.
A new buddy stingray and stick technique for antegrade dissection and re-entry during chronic total occlusion recanalization: a case report
Bing TIAN, Quan-Min JING, Bin WANG, Yan-Bin SU
2019, 16(11): 835-839. doi: 10.11909/j.issn.1671-5411.2019.11.009
Optimal duration for dual antiplatelet therapy with COMBO dual therapy stent
Aydin Huseynov, Michael Behnes, Uzair Ansari, Stefan Baumann, Dirk Lossnitzer, Ibrahim El-Battrawy, Christian Fastner, Martin Borggrefe, Ibrahim Akin
2019, 16(11): 840-843. doi: 10.11909/j.issn.1671-5411.2019.11.001
Anticoagulation in frail older people
Sarah Damanti, Simon Braham, Luca Pasina
2019, 16(11): 844-846. doi: 10.11909/j.issn.1671-5411.2019.11.005