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   Table of Contents - Current issue
April-June 2019
Volume 4 | Issue 2
Page Nos. 39-70

Online since Wednesday, June 26, 2019

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Efficacy and safety of Le-Mai particle in patients with angina pectoris p. 39
Ming Shi, Yaqian Shen, Aifeng Zhang, Zhongwen Zhang, Panpan Hao
This study aimed to verify the efficacy and safety of the Le-Mai particle in patients with angina pectoris. Randomized controlled trials (RCTs) were searched from numerous databases. Clinical symptom improvement was served as the primary endpoint and electrocardiogram (ECG) improvement as the secondary endpoint to testify the efficacy of Le-Mai particle. The safety of Le-Mai particle was also evaluated. Six RCTs were included in our analyses. Two hundred and seventy-nine patients treated with Le-Mai particle in combination with conventional western medicine (CWM) and 278 patients treated with CWM alone were enrolled. Treatment with Le-Mai particle exhibited a better therapeutic effect on both angina symptom improvement (odds ratios [OR] = 3.85, 95% confidence intervals [CI] = 2.38–6.24,P < 0.00001) and ECG improvement (OR = 1.98, 95% CI = 1.38–2.85,P = 0.0002) as compared to the control group. When compared with CWM alone, no significant increase in the adverse reaction was observed in the Le-Mai group. The study provided preliminary evidence that complementary therapy with the Le-Mai particle is effective and safe in patients with angina pectoris.
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Visual and measured clinical phenotypes: Potential targets for cardiovascular prevention p. 43
Chunsong Hu, Tengiz Tkebuchava
This article discusses and briefly reviews several visual and measured clinical phenotypes, which include height, birth weight or preterm birth body mass index, index finger to ring finger distance ratio (2D: 4D), earlobe creases, hair graying or whitening, and xanthoma. As modifiable risk factors and non-modifiable clinical phenotypes (NMCPs), these factors are potential targets for cardiovascular prevention in the new era of precision medicine. A novel score method based on modifiable risk factors and NMCPs can help for more precise diagnosis and prevention of cardiovascular disease.
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Predictors of failure of retrograde approach for percutaneous intervention of coronary chronic total occlusion: A single-center experience p. 47
Jianying Ma, Shufu Chang, Jing Xie, Qing Qin, Rende Xu, Kang Yao, Dong Huang, Feng Zhang, Lei Ge, Juying Qian, Junbo Ge
Objective: The aim of the study is to assess the predictors of failure of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) lesions using a retrograde approach. Methods: The present study retrospectively enrolled all 211 patients who underwent retrograde CTO PCI from January 2009 to December 2015 at Shanghai Institute of Cardiovascular Disease. Multivariate Cox regression analysis was used to assess potential predictors of retrograde CTO PCI failure including sex, vascular access site, sheath size, prior PCI, prior coronary artery bypass grafting, history of myocardial infarction, target vessel of CTO, J-CTO score, retrograde wire crossing collaterals, and reverse controlled antegrade and retrograde subintimal tracking (CART) use. Results: Of the 211 patients studied, retrograde CTO PCI was successful in 115 (54.5%) patients, and in an additional 46 (21.8%) with an antegrade approach after retrograde failure. For the 50 (23.7%) patients who failed both retrograde and antegrade approaches, the most common (50% [25/50]) reason was inability to cross collaterals with the retrograde wire. This group of patients had fewer instances of a prior PCI (P < 0.05). Retrograde CTO PCI failure rate was lower with increasing sheath size and with either radial-only or one radial and one femoral access versus femoral-only access (P < 0.05). A multivariate Cox regression analysis showed that the inability to cross collaterals with the retrograde wire (hazard ratio, 5.52 [95% confidence interval, 2.08–12.81];P < 0.001), no prior PCI (3.27 [1.24–8.58];P = 0.01), and no reverse CART use (4.19 [1.33–13.19];P = 0.03) were an independent predictors of retrograde CTO PCI failure. Conclusion: Independent predictors of retrograde CTO PCI failure were the inability to cross collaterals with the retrograde wire, no prior PCI, and no reverse CART use. Vascular access site and sheath size do not have effect on the success of the retrograde approach.
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Association between echocardiography findings and cardiovascular comorbidities in Indian patients with chronic heart failure p. 53
Rohit Sane, Gurudatta Amin, Snehal Dongre, Rahul Mandole
Background: Various comorbidities contribute to structural and functional changes in congestive heart failure (CHF). Echocardiography is a first-line diagnostic tool for screening and monitoring CHF patients. Hence, it is important to study the association between echocardiographic findings and comorbidities in CHF. Methodology: A retrospective study was conducted using data from CHF patients evaluated at the Madhavbaug clinics between August 2018 and January 2019. Patients were classified based on normal (>55%) and compromised (<55%) left ventricular ejection fraction (LVEF) and grades of diastolic dysfunction (Grade I – impaired relaxation, Grade II – pseudonormal, and Grade III – reversible restrictive). Chi-square test was used to assess the associations between comorbidities and echocardiographic findings (including ejection fraction and grade of diastolic dysfunction). Results: One hundred and thirty-eight patients' data were evaluated. The majority of patients were male (74.15%), and the mean age was 59.15 ± 10.28 years. Sixty-two patients had compromised LVEF, whereas 76 patients had normal LVEF. Most patients (n = 77) had Grade I diastolic dysfunction, followed by Grade II (n = 53) and Grade III (n = 3). Patients with comorbidities including coronary artery disease (CAD) (odds ratio [OR]: 2.3, 95% confidence interval [CI]: [1.13–4.65],P = 0.02), dilated cardiomyopathy (OR: 30.6, 95% CI: [1.75–534.01],P = 0.002), and myocardial infarction (OR: 6.22, 95% CI: [2.45–15.78],P = 0.001) had higher odds of having compromised ejection fraction (LVEF <55%). Hypertension (HTN) (OR: 2.11, 95% CI: [1.02–4.6],P = 0.049) was associated with higher odds of Grade I diastolic dysfunction. Conclusions: Comorbidities such as CAD, dilated cardiomyopathy, and myocardial infarction are associated with increased odds of compromised ejection fraction, whereas HTN is associated with Grade I diastolic dysfunction.
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Effect of WeChat platform on ST-segment elevation acute myocardial infarction reperfusion treatment time and curative effect p. 58
Shuxin Hou, Damin Huang, Jinchun Zhang, Zhihua Li, Honglei Zhang, Hongqiang Liu, Yingmin Lu
Objective: The objective of the study is to construct a regional ST-segment elevation myocardial infarction (STEMI) treatment network system using the WeChat platform as a carrier and to explore the effect of this system on the time to reperfusion treatment and efficacy of treatment for patients with acute STEMI. Materials and Methods: The Department of Cardiology at our hospital constructed a STEMI rescue WeChat group including 120 emergency departments and acute care hospitals in the district. For all suspected STEMIs, relevant medical history data were uploaded to the WeChat group, a physician from the Department of Cardiology was consulted electronically, and this cardiologist was able to inform the local physician of a reperfusion treatment plan. One hundred and seventy-seven STEMI patients were transferred to our hospital within 12 h of presentation, of which 81 cases were transferred before the establishment of the WeChat group (the control group), and 96 cases were transferred using the WeChat system (WeChat group). The time to reperfusion, O-to-FMC time, FMC-to-B time, D-to-B time, average hospitalization stay, and mortality during hospitalization were observed and compared between the two groups. Results: The WeChat group had a lower O-to-FMC time compared with the control group, but this difference was not statistically significant. The FMC-to-B time, the time of D-to-B, and the average days of hospitalization in the WeChat group were all lower compared with those in the control group. The incidence of cardiovascular events and the heart function ratio of the patients after 6 months were compared, and the WeChat group was statistically superior to the control group in relation to these outcomes. Conclusion: The establishment of a STEMI regional treatment network based on the WeChat platform can shorten the time to reperfusion treatment, reduce postreperfusion cardiovascular events, shorten the days of hospitalization, and improve the heart function of patients.
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Tricuspid valve dysfunction due to incarcerated right ventricular lead p. 62
Lili Xu, Cuizhen Pan, Xianhong Shu, Junbo Ge
Here we report a case of severe tricuspid regurgitation related to the pacemaker lead incarcerated in the chordae tendinae, resulting in significantly reduced systolic function of right ventricular and right sided heart failure. The necessity of echocardiography is ignored in the follow-ups after pacemaker implantation, which may be useful for optimal lead placement.
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Primary orthostatic hypertension: A case report and literature review p. 64
Yi-Xi Wang, Yu Wang, Yan Xu, Cong-Cong Xu, Yi-Fei Dong
Orthostatic hypertension (OHT) is a sudden elevation in blood pressure after standing, which is clinically easy to ignore. Most of these OHT patients do not have characteristic manifestations of hypertension and are often diagnosed during physical examination. Most of the blood pressure increase in OHT patients is due to diastolic blood pressure, and the fluctuation is large. An adult patient with OHT was diagnosed and treated, and possible underlying mechanisms were analyzed.
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Prof. Joseph A. Hill, Editor-in-Chief of Circulation, Visited the China Cardiovascular Association and the China Heart House to have a Discussion with Cardiology Plus Editors p. 69

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