2020 Vol. 17, No. 6
Objective To determine the possible association of anti-β1-adrenergic receptors (anti-β1-AR), anti-β2-AR and anti-α1-AR with carvedilol treatment in patients with heart failure (HF). Methods A total of 267 HF patients were prospectively enrolled. Blood samples were measured by an enzyme-linked immunosorbent assay. All of the patients received carvedilol for their HF. Each patient was followed up for six months and their cardiac function was measured. Results The final analysis encompassed 137 patients comprising 65 patients with three autoantibodies (positive group) and 72 patients without all three autoantibodies but with one or two autoantibodies (negative group). The frequency and geometric mean titer of anti-β1-AR, anti-β2-AR, and anti-α1-AR were significantly lower in the group without all three autoantibodies after six months of carvedilol treatment (all P P P Conclusions Carvedilol treatment significantly decreases frequency and geometric mean titer in patients with all three autoantibodies, even up to complete ablation, and significantly improved cardiac function and remodelling. The effect of carvedilol is probably correlated to the presence of all three autoantibodies.
Background Several liver function tests have been identified as predictors of hospitalization for heart failure (HF) and death in patients with chronic HF. The relationship between serum γ-glutamyltranferase (GGT) and albumin (SA) levels with the response to cardiac resynchronization therapy (CRT) has not been reliably determined. The aim of the study was to evaluate the impact of liver function tests on the results of CRT in the elderly. Methods Baseline GGT and SA were assessed before CRT device implantation in the elderly (> 70-year-old) patients. The endpoints were: (1) CRT response defined as > 5% left ventricular ejection fraction improvement and no hospitalization for HF or cardiovascular death; (2) hospitalizations; and (3) mortality. Results Eighty of 138 (58%) included patients were responders at nine months. Compared to responders, the SA levels were not significantly different (35.1 ± 5.4 vs. 33.6 ± 5.5 g/L, P = 0.103); but the GGT levels, higher (81.6 ± 69.3 vs. 54.7 ± 49.6 U/L, P = 0.013) in non-responders to CRT. GGT level was independently associated with non-response to CRT (P P vs. 83%, P = 0.024). Both SA and GGT had no impact on overall (P = 0.220, P = 0.723) mortality. Conclusions Higher level of GGT is an independent predictor of non-response to CRT in patients over age 70 years and is associated with higher risk of hospitalization for AF. Baseline serum levels of albumin and GGT and have no impact on mortality in elderly patients undergoing CRT.
Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes (ACS). In the situation where patients do not present to a facility capable of 24/7 percutaneous coronary interventions (PCI) delays in time to therapy can exceed the recommendation of 90 min or less. This study aimed to evaluate the impact of transfers on performance indices for patients diagnosed with ST-segment elevation myocardial infarction (STEMI). Methods Over a seven month collection period, all patients presenting with symptoms suggestive of ACS and admitted for PCI were studied. Patients were divided into dichotomous groups of direct presentations or transfers from a secondary non-PCI capable hospital with key times recorded, including symptom-onset, first hospital and PCI-capable hospital arrival and balloon inflation times to evaluate time of treatment for STEMI patients. Results Of the 87 patients diagnosed with STEMI, transferred patients experienced statistically significant delays in symptom-onset to the PCI-capable hospital (PCI-H) arrival (215 vs. 95 min, P vs. 160 min, P = 0.009) and first hospital arrival to balloon inflation times (106 vs. 56 min, P n = 9) of transferred patients underwent balloon inflation within 90 min from first hospital arrival, while 60% (n = 19) did within 120 min, although all received balloon inflation within 90 min from arrival at the PCI-H. After controlling for confounding factors of socio-economic status, presentation date/ time and diagnostic category, transferred patients experienced an average 162% longer delays from symptom-onset to PCI-H door arrival, and 98% longer delays in symptom-onset to balloon inflation; compared to patients who present directly to the PCI-H. No statistically significant differences were noted between transferred and direct patients when measured from PCI-H door-to-balloon times. Conclusions This study shows that transferred patients experience a greater overall system delay, compared to patients who present directly for PCI, significantly increasing their time to treatment and therefore infarct times. Despite the majority of transfers experiencing pre-hospital activation, their treatment hospital arrival to balloon times are no less than direct presenters after controlling for confounding factors, further compounding the overall delay to therapy.
Background Previous studies have demonstrated that microRNA-204 (miR-204) is involved in atherosclerosis and vascular calcification. However, the value of miR-204 as the predictive biomarker for cardiovascular disease (CVD) remains unclear. We aimed to evaluate the association between the circulating miR-204 level and ten-year CVD risk based on the Framingham risk score (FRS). Methods In this retrospective study, we enrolled 194 consecutive patients with type 2 diabetes mellitus (T2DM) without CVD in Beijing Anzhen Hospital between January 2015 and September 2016. We used the FRS to evaluate the risk of CVD for each patient. Circulating miR-204 levels were measured by quantitative real-time polymerase chain reaction. Results Circulating miR-204 levels were significantly lower in the group of patients (0.49 ± 0.13) at high risk of CVD (FRS > 20%) than in the low (FRS P P P = 0.001). Receiver-operating characteristic curve analysis showed that the circulating miR-204 level can predict the high risk of CVD with higher specificity than the traditional risk factor of high systolic blood pressure or the protective factor of high-density lipoprotein cholesterol. Conclusions Our study demonstrated that patients with lower circulating miR-204 levels were at high risk for CVD. After adjustment for potential confounders, miR-204 was independently associated with CVD in patients with T2DM.
Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/shaft lesions in unprotected left main coronary artery (ULMCA). Methods & Results A total of 472 patients with isolated ostial/shaft lesions in ULMCA were enrolled, who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The major endpoints of this study were death, repeat revascularization, non-procedural myocardial infarction (MI) and stroke. The median follow-up was twelve years (interquartile range: 9.4–14.0 years) in the overall patients. There were no significant differences of incidence of death (23.3% vs. 25.6%, P = 0.227), repeat revascularization (27.3% vs. 28.4%, P = 0.423), non-procedural MI (20.0% vs. 14.5%, P = 0.561), and stroke (6.1% vs. 9.3%, P = 0.255) between PCI and CABG groups before multivariate adjusting. After adjusting covariates with multivariate Cox hazard regression model, there were still no significant differences between PCI and CABG groups. Conclusions During the median follow-up of twelve years, we found that PCI with DES was as effective and safe as CABG in patients with left main ostial/shaft lesion in this observational study.
Background Vector flow mapping is a novel echocardiographic technique that enables the visualization of the intraventricular flow. We aimed to evaluate and compare the index of hemodynamic dissipative energy loss in patients with hypertension and the ones with nor-motensive, unaffected control subjects. Methods & Results Transthoracic echocardiography was performed in eighty-nine hypertensive patients with preserved left ventricular ejection fraction, fifty-one hypertensive patients with left ventricular hypertrophy (LVH group) and thirty-eight hypertensive patients without LVH (non-LVH group). Forty-two healthy volunteers were enrolled as the control group. The stored images were analyzed to calculate the energy loss. The average energy loss of diastole in the LVH group was significantly increased (controls vs. non-LVH vs. LVH: 7.07 ± 0.91 vs. 12.44 ± 3.14 vs. 16.29 ± 3.17 J/s per m3). Compared with the control group, the energy loss was significantly increased in the LVH group during the different periods in diastole. The energy loss in the non-LVH group was the greatest among the three groups during the atrial contraction period. Conclusions Energy loss provides a promising method for evaluating the energy efficiency in the left ventricle and may be a new indicator of left ventricular cardiac dysfunction.
Objective To compare the short-term clinical effect and electrical parameters of His-purkinje bundle pacing (HPBP) and right ventricular inflow tract septal pacing (RVIP) in the elderly. Methods Between April 2017 and September 2019, sixty patients with indications for permanent cardiac pacing and resynchronization therapy in Beijing Anzhen Hospital were divided into the HPBP and RVIP groups, and were analyzed. A ventricular pacing lead was implanted in left ventricular septal sites with left bundle potentials or His potentials in the HPBP group. The lead was placed in right ventricular inflow tract septal sites close to distal His-bundle regions without potentials from the His-purkinje conduction system in the RVIP group. Lead impedance, R wave amplitude, pacing thresholds, QRS duration, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic diameter (LVEDD), mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio were compared between the HPBP and RVIP groups during the procedure and the short-month follow-up. Results No significant differences were found in lead impedance, R wave amplitude, QRS duration, LVEF, LVEDD, mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio between the HPBP and RVIP groups. However, the pacing threshold was significantly lower in the HPBP group than in the RVIP group (0.7 ± 0.2 vs. 0.9 ± 0.3 V, P = 0.02). Conclusions The efficacy and electrical parameters of HPBP is comparable with RVIP during the procedure and the short-term follow-up.