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REVIEW ARTICLE
Treatment of Hyperlipidemia: Consensus and Controversies
Christoph H Saely, Reinhard R Saely, Heinz Drexel
October-December 2017, 2(4):18-25
DOI:10.4103/cp.cp_4_17  
Based on epidemiological, genetic, and clinical trial data, there is a consensus now that low-density lipoproteins (LDL) cholesterol causes atherosclerosis and that lowering LDL cholesterol reduces the risk of atherosclerotic cardiovascular disease. Current guidelines on lipid management, therefore, focus on LDL cholesterol. The absolute benefit derived from lowering LDL cholesterol is greatest with the highest baseline risk; the most intensive treatment, therefore, is appropriate in the patients at the highest risk. Regarding the choice of drugs, statins are the basis of lipid management; if treatment goals are not met with statins alone, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors can be added to further reduce cardiovascular risk. Several questions remain open to debate. For example, the long-term net benefit of statin treatment in young patients with a low 10-year, but a high lifetime risk of cardiovascular events has not been demonstrated; in the absence of robust data, also lipid management in very old patients remains a question of clinical judgment. Further, given the evidence from clinical trials for further risk reduction with lowering LDL cholesterol below currently recommended targets, there is no universal consent on how low to go with LDL cholesterol. Also, with the availability of potent but expensive treatment options, the cost-effectiveness of lipid management remains a field of controversy. Finally, new lipid drugs are under development that yet has to prove their role in lipid management.
  1,625 269 -
RESEARCH ARTICLES
Safety and efficacy of a modified axillary vein technique for pacemaker implantation
Hui Yang, Hejun Jiang, Qiming Liu, Shenghua Zhou, Xuping Li, Zhenjiang Liu, Zhihong Wu, Chenlu Wu
July-September 2018, 3(3):104-107
DOI:10.4103/cp.cp_21_18  
Context: Axillary vein puncture is an alternative method for pacemaker leads implantation. However, the safety and effectiveness of axillary vein puncture become an issue for debate now. Aims: The aim of this study was to investigate the safety, feasibility, and efficacy of a modified axillary vein technique for pacemaker implantation. Settings and Design: This modified axillary vein technique refers to a novel axillary vein puncture method combined with caudal 35° fluoroscopy and surface anatomic landmarks including deltopectoral groove, coracoid process, and the first rib. Subjects and Methods: This technique was applied to 139 consecutive patients referred for pacemaker implantation between March 1, 2016, and December 31, 2016, at our department. Statistical Analysis Used: None. Results: Success rate of pacemaker implantation was 96.4% (134/139). Five patients (3.60%) were switched to an alternate approach for leads implantation. There were no procedure-related complications such as pneumothorax, hemopneumothorax, major bleeding, and significant pocket hematoma. Conclusion: This modified axillary vein puncture strategy combining caudal 35° fluoroscopy and surface anatomic landmarks is safe and feasible for pacemaker implantation.
  1,544 254 -
REVIEW ARTICLE
Progeria and accelerated cardiovascular aging
Brandon K Walther, Yanhui Li, Rajarajan Amirthalingam Thandavarayan, John P Cooke
July-September 2018, 3(3):81-89
DOI:10.4103/cp.cp_26_18  
Hutchinson–Gilford Progeria syndrome (HGPS) is characterized by accelerated aging leading to death in the teen years, usually due to severe coronary and/or carotid disease. The clinical presentation includes stunted growth, alopecia, loss of subcutaneous fat, osteoporosis, and cardiovascular disorders occurring in late childhood and the teen years including hypertension and accelerated vascular aging that precipitates myocardial infarction and cerebrovascular attacks. The disease is a nuclear laminopathy, due to a Lmna gene mutation. The aberrant protein (Progerin) accumulates in and distorts the nuclear envelope. We review the genetic and biochemical mechanism of HGPS; the clinical presentation with special attention to the cardiovascular pathology and complications; current therapeutic developments to address the disease; and the results of the clinical trials attempting to translate basic research insights into therapeutic benefit. An understanding of HGPS may lead to better treatment of other age-related disorders, particularly cardiovascular diseases.
  1,349 230 1
RESEARCH ARTICLES
Effects of exercise training on systolic and diastolic function of mice with diabetic cardiomyopathy
Guo Lu, Xu Zhang, Zhongguang Sun, Xiaowei Shi, Tingliang Liu, Xin Xu
October-December 2017, 2(4):1-6
DOI:10.4103/cp.cp_1_18  
Objective: This study aims to evaluate the effects of exercise training on heart function of mice with diabetic cardiomyopathy. Materials and Methods: Twenty-four healthy C57 mice were randomly divided into three groups high-fat exercise group (n = 8), high-fat control group (n = 8), and low-fat control group (n = 8). High-fat groups were fed with a high-fat diet for 16 weeks, and the high-fat exercise group was subjected to aerobic treadmill exercise and resistance exercise for 8 weeks. After 24 weeks, the cardiac structure and function of the three groups were detected, and the indexes of the mouse heart were analyzed and compared. Results: The high-fat control group maintained hyperglycemia. The results of echocardiography showed that left ventricular eject fraction in the high-fat exercise group and the low-fat control group was significantly higher than that of the high-fat control group (68.99% ± 2.04% vs. 60.41% ± 2.31%, 66.16% ± 2.12% vs. 60.41% ± 2.31%, P < 0.01). In the diastolic function of the heart, blood flow peak velocities of the early peak at the mitral valve in the high-fat exercise group and the low-fat control group were significantly higher than that in the high-fat control group (709.73 ± 45.48 mm/s vs. 441.51 ± 44.83 mm/s, 632.92 ± 27.22 mm/s vs. 441.51 ± 44.83 mm/s, P < 0.01), the peak velocities of the atrial peak at the mitral valve were significantly lower than that of the high-fat control group (443.77 ± 18.09 mm/s vs. 523.67 ± 57.87 mm/s, 460.36 ± 18.24 mm/s vs. 523.67 ± 57.87 mm/s, P < 0.05), and the ratio of E/A was significantly higher than that of the high-fat control group (1.63 ± 0.06 vs. 0.85 ± 0.045, 1.38 ± 0.072 vs. 0.85 ± 0.045, P < 0.01). Myocardial performance index decreased (0.86 ± 0.095 vs. 0.97 ± 0.091, 0.88 ± 0.073 vs. 0.97 ± 0.091, P > 0.05), but there was no significant difference. Conclusion: The above data indicated that 8 weeks of exercise training can improve the heart function of mice with diabetic cardiomyopathy, especially diastolic heart function. Left ventricular systolic function had some trend to improve, but there is no statistical difference. Exercise intervention may promote the rehabilitation of diabetic cardiomyopathy.
  1,349 213 1
GUIDELINES AND CONSENSUS
Strategic roadmap of percutaneous coronary intervention for chronic total occlusions
Junbo Ge on behalf of Chronic Total Occlusion Club China (CTOCC)
January-March 2018, 3(1):30-37
DOI:10.4103/cp.cp_7_18  
  1,301 190 -
RESEARCH ARTICLES
Effect of atorvastatin and trimetazidine combination treatment in patients with NSTE-ACS undergoing PCI
Jiang-You Wang, Han Chen, Hua Yan, Xi Su
April-June 2018, 3(2):41-46
DOI:10.4103/cp.cp_11_18  
Background: Our study sought to assess the effect of atorvastatin (ATV) and trimetazidine (TMZ) combination treatment in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Materials and Methods: Two hundred and fifty patients with NSTE-ACS who were undergoing PCI were enrolled in this study. Standard secondary prevention of coronary heart disease drug treatment was administered to both the groups (the ATV + TMZ group and the ATV group). In the ATV + TMZ group, patients were given 80mg of the combination medical orally 12h before PCI, 60mg 30min before PCI, and a further 20mg every day for 30t days after PCI, and. In the ATV group, patients were given only 80mg orally 12h before PCI, with a further 20mg every day for 30t days after PCI. Echocardiography was executed and plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) levels were measured just prior to the PCI and at 30 days after PCI. The major cardiovascular events (MACE) were also evaluated in both groups 30 days after PCI. Results: MACE occurred in 14.17% of patients in the ATV group and 6.50% of those in the ATV + TMZ group (P = 0.047). NT-pro-BNP levels were decreased 30 days after PCI for both groups; however, NT-pro-BNP levels in the ATV + TMZ group were significantly lower than those in the ATV group (P < .05). Cardiac function in NSTE-ACS patients, as reflected by the increased left ventricular ejection fraction, fractional shortening as well as decreased left ventricular end-diastolic dimension (P < .05) increased in all groups at 30 days after intervention, but cardiac function parameters were more significantly improved in the group administered with ATV + TMZ (P < .05). Conclusions: Our study suggests that short-term pretreatment with the combination of ATV and TMZ administration before PCI could reduce the incidence of MACE, further decrease NT-pro-BNP levels and improve cardiac function compared to a single administration of the ATV.
  1,275 212 1
VIEWPOINT
Cardiogenic shock: Dopamine or norepinephrine? It's a question
Ben He, Lingcong Kong, Junbo Ge
January-March 2017, 2(1):1-4
DOI:10.4103/2470-7511.248216  
  1,287 150 -
GUIDELINE AND CONSENSUS
ST-Segment elevation acute myocardial infarction prehospital thrombolytic therapy: Chinese expert consensus
Hongbin Yan, Dingcheng Xiang, Hongmei Liu, Hui Chen, Jiyan Chen, Yuguo Chen, Yundai Chen, Yingjie Chu, Weiyi Fang, Xianghua Fu, Chunji Lie, Wei Mao, Shuming Pang, Ruofei Shi, Xi Su, Yan Wang, Guirong Wang, Weimin Wang, Mei Xu, Lixia Yang, Hailing Yu, Zuyi Yuan, Zhijie Zheng, Yong Huo
April-June 2018, 3(2):71-80
DOI:10.4103/cp.cp_12_18  
Acute myocardial infarction (AMI) still seriously threatens the health of the people in our country. The situation is even more severe in the vast urban and rural areas in China. Timely treatment of AMI patients to reduce mortality and protect heart function is very important. Prehospital thrombolysis treatment has great significance in urban and rural areas outside the big cities. To this end, the Chinese Medical Doctor Association's chest pain professional committee and the Chinese Medical Rescue Association's Cardiovascular Emergency Sub-Commission organized relevant experts to formulate this consensus, aiming to help prehospital medical emergency personnel select the best treatment strategies for patients with AMI. However, the final decision on a specific patient should be made by the prehospital emergency personnel together with the patients and their family members.
  1,250 138 -
RESEARCH ARTICLES
Association of serum triglycerides with microalbuminuria in nondiabetic hypertensive patients
Lei Huang, Jing Luo, Yifei Dong, Peng Lu, Xi-Xin Ji, Jian Liu, Ping Li, Xiaoshu Cheng
January-March 2018, 3(1):8-14
DOI:10.4103/cp.cp_5_18  
Background: Triglycerides (TG) levels were associated with microalbuminuria in diabetes. However, this association was barely investigated in non-diabetic hypertensive patients. We aimed to investigate such an association in non-diabetic hypertensive patients and the factors would affect it. Methods: We enrolled 445 eligible non-diabetic hypertensive patients and analyzed the association between TG and microalbuminuria. Results: Urinary microalbumin levels were significantly increased in patients with high TG levels (≥ 1.7 mmol/L). Multivariate logistic regression analysis identified that ln (TG) [odds ratio (OR): 2.273, 95% confidence interval (CI): 1.140 to 4.532, P = 0.020] were independently associated with microalbuminuria in all patients. Multinomial logistic regression analysis further revealed that highest tertile of TG level (≥ 1.76 mmol/L) significantly correlated with microalbuminuria (OR: 2.164, 95% CI: 1.336 to 3.507, P = 0.002) and the association remained significant after adjustments of sex, body mass index, ln(age), ln(systolic blood pressure), ln[diastolic blood pressure (DBP) (OR: 1.990, 95% CI: 1.197 to 3.308, P = 0.008). Association between TG and microalbuminuria was no longer significant when patients were limited to those with low-density lipoprotein cholesterol (LDL-C) treatment target achieved. However, in a forced model of multivariate regression analysis by eliminating ln (DBP), ln (TG) resumed the association with microalbuminuria (OR: 2.722, 95% CI: 1.122 to 6.605, P = 0.027). Conclusions: TG levels were associated with microalbuminuria in non-diabetic hypertensive patients, and the independence of association was supposed to be affected by baseline LDL-C and blood pressure levels.
  1,223 160 -
GUIDELINE AND CONSENSUS
Guidelines for comprehensive prevention and treatment of cardiovascular diseases in community populations (The Trial)
Yong Huo, Junbo Ge
October-December 2017, 2(4):26-37
DOI:10.4103/cp.cp_6_17  
  1,203 176 -
REVIEW ARTICLE
Protection of coronary circulation by remote ischemic preconditioning: An intriguing research frontier
Elpidio Santillo, Raffaele Antonelli-Incalzi
January-March 2018, 3(1):21-29
DOI:10.4103/cp.cp_9_18  
Ischemic preconditioning is a protective phenomenon, by which brief ischemic stimuli in a vascular bed are able to counteract the damage from a longer subsequent ischemia. Preconditioning may also confer protection from ischemia to distal tissues and organs. In this case, ischemic preconditioning is known as remote ischemic preconditioning (RIPC). RIPC can be safely and easily reproduced in clinical settings. Indeed, over the past years, its protective actions have been tested in various clinical settings, including cardiac surgery and elective percutaneous coronary interventions. However, translational studies on RIPC have provided conflicting results on reduction of mortality. Recently, studies in humans have investigated the effects of RIPC on coronary circulation, showing that RIPC could have a protective effect on coronaries. This recent area of research may offer innovative insights for designing translational studies on RIPC, unveiling new mechanisms by which RIPC protects the heart. The aims of the present manuscript are to summarize the available clinical evidence on RIPC efficacy for cardioprotection and to review studies assessing the effects of RIPC on coronary circulation in humans.
  1,211 150 -
REVIEW ARTICLES
Soccer related emotion and stress-induced cardiovascular events
Chunsong Hu, Tengiz Tkebuchava
April-June 2018, 3(2):66-70
DOI:10.4103/cp.cp_14_18  
Some say soccer is a stimulant and others say that it is a jinx due to the strong excitement and anxiety that players and fans experience during and following soccer matches. Unexpected adverse events related to these emotions have been documented and include major cardiac events and death. For this reason, soccer may be called a “killer” by emotion. This article reviewed the literature for evidence relating to soccer clashes, riots and emotional stress-induced acute cardiovascular events. Mechanisms were also explored, and included blood pressure abnormalities, coronary heart disease, acute coronary syndrome or acute myocardial infarction, arrhythmia, sudden cardiac arrest, sudden cardiac deaths, and stroke.
  1,134 153 -
RESEARCH ARTICLES
Effects of Shensongyangxin capsule on myocardial connexin 40 expression in diabetic rat model
Da-Bin Pan, Ji-Min Chen, Shi-You Gao, Lin-Tao Zha, Xiang-Rong Xie, Heng Cao
October-December 2017, 2(4):11-17
DOI:10.4103/cp.cp_3_17  
Objective: To investigate the effects of Shensongyangxin (SSYX) capsule on myocardial expression of connexin 40 (Cx40) in diabetic rat model. Materials and Methods: Thirty-one male Sprague-Dawley rats (SD, 8 weeks old, weighing 220 g) were randomly divided into three groups: normal control group (NC, n = 10), diabetic group (diabetes mellitus [DM], n = 9), and diabetes plus SSYX group [SDM], n = 12). SD rats were injected intraperitoneally with streptozotocin (SZT, 65 mg/kg) to make the diabetic rat model. SDM group was given daily SSYX 1 g/kg by gavage and NC group and DM group were given a daily amount of distilled water by gavage. The expression levels of Cx40 in atrial and ventricular muscles were analyzed by Western blot techniques. Hematoxylin and eosin staining technique was used to observe the changes of myocardial structure; the distribution of myocardial Cx40 was analyzed by immunofluorescence technique. Results: Cx 40 levels in the atrial and ventricular muscle were lower in DM group than in the NC group (P < 0.05). The cardiac muscle cells were arranged in order in the NC group. Extensive necrosis and apoptosis of myocardial cells were noted accompanied by the disorder of permutation, adipose tissue, and fibrous tissue in DM group. In the SDM group, the cardiac muscle cells were arranged orderly, but fibrous tissue and vasculitis were observed. Immunostaining showed that the expression of Cx40 in the myocardium was distributed at the end of the long axis of myocardial cells with a ladder-like distribution in the NC group. The expression of Cx40 in the myocardium was mostly distributed on the side of the long axis of myocardial cells in the DM group. The expression level of Cx40 in atrial muscle was increased, and the distribution in the SDM group was primarily lateral. Conclusions: The expression of Cx40 in the myocardium was decreased and mainly distributed on the sides in DM group. SSYX capsule upregulated the expression of Cx40 in the atrium in diabetic rats. No significant effect was noted on the expression and distribution of Cx40 in the ventricular muscle.
  1,079 150 -
Role of three-dimensional transesophageal echocardiography in transcatheter aortic valve implantation of bicuspid aortic valve stenosis: A controlled study and comparison with tricuspid aortic valve stenosis
Nianwei Zhou, Cuizhen Pan, Weipeng Zhao, Daxin Zhou, Wenzhi Pan, Xiaochun Zhang, Kefang Guo, Xianhong Shu, Xiaolin Wang, Junbo Ge
January-March 2018, 3(1):1-7
DOI:10.4103/cp.cp_4_18  
Aims: This study aims to investigate the application of three-dimensional transesophageal echocardiography in aortic valve stenosis for the assessment of aortic valve ring size, to monitor the procedure of transcatheter aortic valve implantation (TAVI), and perform postoperative follow-up. Methods: Eighteen patients with bicuspid valve malformation and severe aortic stenosis bicuspid aortic valve (Group BAV-AS) and 23 patients with a tricuspid valve and severe aortic stenosis trileaflet aortic valve (Group TAV-AS) were enrolled in this study. Preoperative routine transthoracic echocardiographic (TTE) examination and two- and three-dimensional transesophageal echocardiography (2D and 3DTEE) were performed, followed by perioperative 2D and 3D TEE monitoring and postoperative routine TTE at 6-month follow-up. Results: Both BAV-AS and TAV-AS patient groups were successfully implanted with bioprosthetic valves under 3DTEE guidance. Parameters at 6-month postoperatively, including prosthetic valve orifice area, mean aortic transvalvular pressure gradient, and left ventricular ejection fraction, showed significant improvement compared with baseline measures (P < 0.0001) in both the groups. No differences were observed between the groups. The maximum diameter of the aortic annulus and eccentricity index were larger in the BAV-AS group than in the TAV-AS group, whereas the minimum diameter of the aortic annulus was larger in the latter (both P < 0.0001) after TAVI. Moreover, the values of maximum and minimum diameters on 3DTEE were strongly correlated with those on multidetector computed tomography. Conclusions: TEE is capable of clearly displaying the morphology of aortic valves and valve rings and precisely quantifying the size of the aortic annulus, thereby playing an essential role during preoperative and perioperative periods. The postoperative shape of the prosthetic valve ring was more oval (larger than normal eccentricity index) in the BAV-AS group and more circular (smaller than normal eccentricity index) in the TAV-AS group.
  1,083 145 -
Prognostic impact on Type B acute aortic dissection with renal insufficiency: A single-center study
Xue Bai, Bao-Zhu Wang, Karmacharya Ujit, Zi-Xiang Yu, Qian Zhao, Xiang Ma, Yi-Tong Ma
January-March 2018, 3(1):15-20
DOI:10.4103/cp.cp_6_18  
Aims: The aim was to study the impact of renal insufficiency on type B acute aortic dissection (AAD), in terms of in-hospital mortality and long-term survival. Materials and Methods: A total of 241 consecutive patients with type B AAD from 2007 to 2014 were enrolled. Based on estimated glomerular filtration rate, two groups were formed: Group A, with e-GFR <60 ml/min/1.73 m2 and Group B, with e-GFR ≥60 ml/min/1.73 m2 and were compared. Logistic regression and Cox regression analyses were used to identify predictors of in-hospital mortality, mortality during follow-ups, and long-term survival. Results: There was no significant difference in general characteristics and hemodynamic status between the two groups (P > 0.05). Both groups received main cardiovascular drugs and/or interventional therapies (P > 0.05). Group A had longer coronary care unit stays than Group B (P < 0.05). Multivariate logistic regression model showed white blood cell (WBC) count (odds ratio [OR], 1.107; 95% confidence interval [CI], 1.016–1.206; P < 0.05), e-GFR < 60 ml/min/1.73 m2 (OR, 4.809; 95% CI, 1.716–13.480; P < 0.05), and in-hospital hypotension (OR, 13.87; 95% CI, 2.544–75.591; P < 0.05) as significant predictors for in-hospital mortality. This was also significant in Cox regression analysis: WBC count (Hazard ratio (HR), 1.108; 95% CI, 1.029–1.194, P < 0.05), e-GFR <60 ml/min/1.73 m2 (HR, 2.572; 95% CI, 1.014–6.524; P < 0.05), and in-hospital hypotension (HR, 3.309; 95% CI, 1.133–9.666; P < 0.05). Kaplan–Meier analysis showed Group A having much lower cumulative survival than Group B. Conclusion: This study shows that moderate-to-severe renal insufficiency is an independent predictor of mortality in type B AAD both during hospital stay and on subsequent follow-ups.
  1,022 126 -
Hemostasis and clotting markers and its significances in unstable angina pectoris patients complicated with diabetes mellitus
Jian-lin Ma, Yan Zhou, Jia-ming Zhang, Li-ning Ma, Haitao Li, Xiangjie Ma, Liao Wang
October-December 2017, 2(4):7-10
DOI:10.4103/cp.cp_2_17  
Background: Recent studies have confirmed that patients with unstable angina pectoris (UAP) complicated with diabetes mellitus(DM) have obvious per-thrombosis state. However, it is not clear that the changes of the hemostasis and clotting markers are very clear. Therefore, this paper is to determine the hemostasis and clotting markers in patients with UAP complicated with DM and those without DM and compared with the control group. Methods: Forty patients with UAP, forty patients with UAP complicated with DM, and forty healthy participants were included in the study as UAP group, complication group, and control group, respectively. Levels of platelet membrane glycoprotein(GP), Von Willebrand (vWF), plasminogen, antithrombin III(ATIII), factor VIII-related antigen(VIII: Ag), platelet membrane glycoprotein-140(GMP-140), protein C(PC), factor II activity(FIIa), tissue plasminogen activity(t-PA), PA inhibitor(PAI), D-dimer, and thromboxane B2(TXB2) were measured in all groups. Results: Compared with a control group and UAP group, there were significant changes of GP, vWF, ATIII, VIII: Ag, GMP-140, PC, FIIa, t-PA, PAI, D-dimer, and TXB2 in complication group (P<0.05, or P <0.01). Compared with control group, there were significant changes of GP, vWF, ATIII, VIII: Ag, GMP-140, PC, FIIa, t-PA, PAI, D-dimer, and TXB2in UAP group (P <0.05, or P <0.01). Conclusions: There are significant changes of hemostasis and clotting markers in patients with UAP, especially in those complicated with DM, which may be an important reason for the poor prognosis of these patients.
  989 134 -
REVIEW ARTICLE
Cholesterol-mediated regulation of angiogenesis: An emerging paradigm
Lingping Zhu, Qilin Gu, Longhou Fang
January-March 2019, 4(1):1-9
DOI:10.4103/cp.cp_5_19  
Angiogenesis, the fundamental process that generates new blood vessels from parental vessels, is essential for embryogenesis and pathogenesis. A variety of underlying molecular and cellular mechanisms control angiogenesis. In this review, we focus on a unique mechanism of action – cholesterol-regulated angiogenesis. We will discuss lipoproteins, including low-density lipoprotein and high-density lipoprotein, cholesterol-rich lipid rafts/caveolae, apoA-I-binding protein (AIBP, also known as NAXE)-regulated cholesterol efflux, the effect of the hydroxycholesterol-activated nuclear receptor liver X receptor α/β on the proangiogenic vascular endothelial growth factor receptor 2 and antiangiogenic Notch signaling, and cholesterol-modified sonic hedgehog signaling. These pathways can be exploited, either alone or in conjunction with the currently available regimen for angiogenesis treatment, to control neovascularization in dyslipidemia. A treatment protocol for angiogenesis that takes into consideration cholesterol management might constitute an important component in precision and personalized medicine.
  909 182 -
RESEARCH ARTICLES
Acute effect of air pollutant sulfur dioxide on acute myocardial infarction mortality from 2011 to 2017 in Jinan City
Tiantian Zhang, Kunkun Yu, Lin Zhou, Liangliang Cui
April-June 2018, 3(2):47-52
DOI:10.4103/cp.cp_18_18  
Objectives: The objective of this study is to quantitatively analyze the acute effects of atmospheric pollutant sulfur dioxide (SO2) on acute myocardial infarction (AMI) death in residents of Jinan City. Methods: A descriptive analysis of data on daily weather, air pollutants, and residents' AMI death events was collected from 2011 to 2017 in Jinan city. A generalized additive model (GAM) based on the Quasi-Poisson regression was used to analyze the associations of AMI deaths and SO2. The lag effect of current day (lag0~lag3) and cumulative lagged effect (lag01~lag03) were explored. The excess risk (ER) and 95% confidence interval (CI) of AMI deaths were calculated for every 10 μg/m3 increase in SO2. Results: A total of 40,843 AMI deaths occurred between 2011 and 2017, with a daily average of 16 deaths. During the same period, the average annual value of SO2was 65 μg/m3. An increase in SO2concentration of 10 μg/m3 was associated with an increased risk of death related to AMI at lag 1 by 0.35% (95% CI: 0.06%–0.64%). Especially in cold months, a higher increased risk of 0.49% (95% CI: 0.19%–0.79 %) for AMI death was observed with SO2a 10 μg/m3 increase. While there was a significant cumulative hysteresis effect, the maximum cumulative hysteresis effect appeared in lag 02. Conclusions: The atmospheric pollutant SO2in Jinan City has a significant acute effect on the risk of death from AMI , especially a higher increased risk was observed in cold months.
  930 148 -
Safety and efficiency of a novel argus optical coherence tomography: A preclinical experiment
Jiahui Chen, Yizhe Wu, Li Shen, Jiasheng Yin, Rui Wang, Xucheng Lv, Han Chen, Meng Ji, Qibing Wang, Juying Qian, Junbo Ge
July-September 2018, 3(3):90-96
DOI:10.4103/cp.cp_20_18  
Aims: This study investigated the application of the domestic Argus Insight-100 optical coherence tomography (OCT) system in porcine arteries and to evaluate the efficiency and safety of Insight-100°CT immediately after implantation and at 4-week follow-up. Subjects and Methods: Eight porcine arteries were implanted with HELIOS drug-eluting stents. Scans were performed with Insight-100 and C7-XR OCT immediately after implantation and at 4-week follow-up, respectively, to obtain lumen images and measured data. Statistical Analysis Used: SPSS v22 software was used for statistical analysis. Results: Both the Insight-100 and C7-XR scans were successfully performed during the implantation and follow-up. Parameters at 4-week postoperatively showed no significant difference between these two groups. No differences were observed in the reference vessel minimal lumen diameters between Insight-100 and C7-XR in the same frame (2.59 ± 0.18 mm vs. 2.60 ± 0.23 mm, respectively, P = 0.91 and 2.83 ± 0.27 mm vs. 2.98 ± 0.27 mm, respectively, P = 0.19). Moreover, the values of mean lumen diameter in the stent segment are comparable between Insight-100 and C7-XR (2.91 ± 0.11 mm vs. 2.97 ± 0.16 mm, P = 0.50). At 4-week follow-up, the mean lumen diameter of Insight-100 was 2.54 ± 0.28 mm, while that of C7-XR was 2.55 ± 0.32 mm, without difference between two groups (P = 0.92). Conclusions: The Argus OCT system appears to be safe during implantation and follow-up. The efficacy and measurement accuracy of Argus OCT is equivalent to that of the C7-XR.
  870 156 -
REVIEW ARTICLES
Clinical benefits of renal denervation besides blood pressure reduction
Han Chen, Li Shen, Junbo Ge
April-June 2018, 3(2):58-65
DOI:10.4103/cp.cp_10_18  
Hypertension (HTN) is currently one of the most common chronic diseases, among which some cases are poorly controlled and defined as resistant HTN (RH). Through years of exploration, it has been discovered that hyperactivity in the sympathetic nervous system and the renin–angiotensin system (RAS) initiates the development of RH, followed by other chain reactions in inflammation and oxidative injury. Attributed to their shared pathogenesis with communal cytokines and factors, other comorbidities of HTN, usually associated with cardiovascular and metabolic pathophysiology, often occur alongside primary symptoms, namely, atherosclerosis, heart failure, arrhythmia, and glucose metabolic disorder. Renal denervation (RDN) was first introduced as an alternative measure to help alleviate RH. Renal denervation's clinical relevance comes from directly cutting down afferent and efferent renal nerves, resulting in fewer nerve impulses transmitted to central nervous system and peripheral target organs, and less RAS activation, resulting in lower blood pressure. However, the practical effects of RDN have extended beyond lowering blood pressure and and and plays a role in anti-inflammation and antioxidation pathways. In this review, we briefly summarize the possible mechanism and beneficial clinical effect of RDN treatment in atherosclerosis improvement, cardioprotection, and diabetes remission.
  849 150 -
CASE REPORT
Surgical intervention for left main compression syndrome due to severe secondary pulmonary hypertension
Laichun Song, Ming Xu, Chao Tao, Lei Shi, Bo Wang, Huadong Yu, Xufa Chen, Liang Tao, Xi Su
October-December 2017, 2(4):38-42
DOI:10.4103/cp.cp_5_17  
A 51-year-old man presented with non-ST-elevation myocardial infarction due to extrinsic compression of the left main coronary artery (LMCA) caused by a dilated pulmonary artery (PA) with secondary pulmonary hypertension and was successfully treated with surgical intervention including pulmonary angioplasty, atrial septal defect correction, and thromboendarterectomy. Imaging modalities were extremely useful in making the diagnosis and providing follow-up of LMCA compression syndrome in this case. During the follow-up, a sufficient hemodynamic improvement was obtained, without exacerbation of the PA dilatation, resulting in the absence of compression of the LMCA.
  882 115 -
RESEARCH ARTICLES
Clinical characteristics and antithrombotic status in 621 very elderly hospitalized patients with atrial fibrillation
Wen Liu, Zhi-Feng Qiu, Li Wang, Yan-Fang Zhang, Jia-Nan Chen, Lei Wu, Jun-Zhou Xin
April-June 2018, 3(2):53-57
DOI:10.4103/cp.cp_13_18  
Background: The prevalence of atrial fibrillation (AF) increases with age and is associated with high morbidity and mortality. The main objective of this study is to describe the clinical characteristics and antithrombotic status and the factors that determine antithrombotic use in hospitalized elderly patients with AF. Methods: Data were collected involving patients hospitalized at the First Affiliated Hospital of Shihezi Medical University from June 2015 to September 2017. Results: A total of 621 patients with an average age of 82.4 ± 5.0 years (42.3% females; 91.8% Han) were included. The prevalence of risk factors and cardiovascular disease: hypertension (56.5%), heart failure (38.2%), coronary artery disease (76.8%), and carotid atherosclerosis (21.3%). Among the 621 patients, 35.7% were taking oral anticoagulant therapy (OAT) including warfarin (25.6%) or a novel oral anticoagulant (10.1%), 32.4% of patients were taking oral antiplatelet therapy, and 31.9% received 17 anticoagulant therapy. According to the European Guidelines for AF management, CHA2DS2-VASc score was used for stroke risk stratification. All patients in this study had a score of ≥2; However, the rate of OAT was 35.7%. Follow-up data were available for 97.3% of the patients (n = 604), of which 26.6% of patients (n = 159) were deceased and 16.75% of patients (n = 104) continued to receive anticoagulation treatment. Hospitalized patients older than 80 years with AF showed numerous comorbidities. The percentage of appropriately anticoagulated patients was suboptimal according to CHA2DS2-VASc score, with only 35.7% of those requiring treatment receiving it. Conclusion: The percentage of patients with AF appropriately anticoagulated at the First Affiliated Hospital of Shihezi Medical University is at a substandard level.
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Association between extremely cold weather and ischemic heart disease-related death during 2011–2017, Jinan City
Jinyu Man, Kunkun Yu, Lin Zhou, Liangliang Cui
July-September 2018, 3(3):97-103
DOI:10.4103/cp.cp_24_18  
Objective: The objective of the study is to evaluate the acute effects of extreme cold weather and cold waves on the risk of death from ischemic heart disease (IHD) in Jinan city. Methods: Daily meteorological data, air pollution data, and IHD-related death data in Jinan from January 1, 2011, to December 31, 2017, were collected. The extreme cold weather was defined as temperatures below the 10th percentile (−1.6 C), 5th percentile (−3.3 C), and 1st percentile (−6.4 C) of the daily average temperature during the study period, expressed as P10, P5, and P1 respectively. Cold strokes were defined as P10, P5, or P1 temperatures lasting for 3 days or more, and were expressed as Cold stroke I, Cold stroke II, and Cold stroke III, respectively. A time-stratified case-crossover study was used to assess the acute effects of extreme cold weather and cold strokes on IHD-related deaths. Results: During the 1486 days of the 2011–2017 cold months, 50,845 IHD deaths were detected with an average of 34 daily deaths. The relatively cold years were observed in 2011, 2012, 2013 and 2016 during the study, and the coldest was for 2012. The maximum effects of P10, P5, and P1 on IHD deaths occurred on lag6, lag6, and lag2, respectively, and the results were 1.08 (95% confidence interval [CI]: 1.04, 1.12), 1.10 (95% CI: 1.04, 1.15), and 1.20(95% CI:1.09, 1.32), respectively. The maximum effect of Cold stroke I and Cold stroke II on IHD mortality risk was 1.09 (95% CI: 1.04, 1.14) and 1.11 (95% CI: 1.04, 1.19), respectively, at lag6 and lag2. Conclusions: Extremely cold weather and cold strokes in the cold months of 2011–2017 in Jinan City significantly increased the risk of acute death from IHD. It was also found that the occurrence of cold weather and cold strokes after warm years can further increase the risk of acute death from IHD.
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GUIDELINE AND CONSENSUS
Transcatheter aortic valve replacement: Team construction and operation specifications recommended by Chinese experts
Junbo Ge
July-September 2018, 3(3):108-113
DOI:10.4103/cp.cp_29_18  
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CLINICAL REGISTRY STUDY
Comparing an internet-based medical model with a conventional medical model in the management of patients with hypertension in China: Methodology of a cluster randomized study
Jie Jiang, Ningling Sun, Jianping Li, Xinhua Zhang, Bei Shi, Chen Yao, Dong Zhao, Hongwei Sun, Shengyuan Wu, Chengming Gu, Yong Huo
October-December 2018, 3(4):117-121
DOI:10.4103/cp.cp_31_18  
Background: The awareness, treatment, and control of hypertension are low in China. New and effective management model other than conventional hospital-based practices is needed to optimize the assessment and treatment of hypertension. Objectives: The objective of the study is to design a study that compares blood pressure (BP) control rate in hypertensive patients managed through an internet-based medical model versus conventional medical model. Methods: The study designed is a cluster randomized, unblinded controlled study which will be performed in 14 primary care clinics in Guizhou Province in southwest China. Sites will be randomized to provide BP management services to the patient through an internet-based medical model including home BP monitoring (HBPM) and telemonitoring by primary care physicians, or through a conventional medical model including HBPM and periodical visits to the clinic. Patients aged 45–75 years with two measurements of resting systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg on different days during screening will be enrolled. The primary endpoint is the BP control rate, defined by the percentage of patients achieving target office BP (SBP <140 mmHg and DBP <90 mmHg). Using a superiority design, at least 958 patients were calculated to be sufficient to detect a 10% difference in BP control rate between groups, with a power of 85% and 15% drop out rate. Other outcomes include BP value, BP variability, treatment compliance, medical expense, and treatment satisfaction. Discussion and Conclusion: The results of the trial will be applicable to primary care services in China, especially in the west of China, where medical resources are less readily available. If successful, the internet-based management model with HBPM and telemonitoring from primary care physician may help to improve the BP control in patients in China. Clinical.gov Registration: NCT03527563.
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