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Coverpage
January-March 2021
Volume 6 | Issue 1
Page 1-79
Online since Tuesday, March 30, 2021
Accessed 3,030 times.

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PREFACE  
P. 1
Yu-Xiang Dai, Jun-Bo Ge
DOI:10.4103/2470-7511.312600  
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GUIDELINE AND CONSENSUS Top
P. 4

DOI:10.4103/2470-7511.312595  
Myocardial infarction (MI) is one of the most common and important causes of heart failure (HF). In China, HF after MI has a high incidence, and the prognosis is poor. In recent years, although China has successively issued guidelines for the diagnosis and treatment of MI and HF, respectively, there remains a lack of unified guidance for the diagnosis, treatment, and prevention strategies of HF after MI. Experts from the Branch of Cardiovascular Physicians, Chinese Medical Doctor Association, and the Chinese Cardiovascular Association compiled this consensus, covering the epidemiology, pathogenesis, diagnosis, treatment, prevention, and management of HF after MI. It aims to promote and optimize standardized clinical strategies for the disease management and improve patient outcome.
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OPINION Top
P. 21
Zhi-Yi Ma
DOI:10.4103/2470-7511.312598  
Due to the difference in drug treatment strategies between the “2020 International Society of Hypertension Global Hypertension Practice Guidelines” and the “Expert consensus on the management of hypertension in the young and middle-aged Chinese population” consensus, I made a hypothesis on hypertension mechanisms. The mechanisms behind hypertension differ between age groups. For instance, the sympathetic nervous system might play more important role young and middle-aged hypertensive patients. In this commentary, hypertension mechanisms were classified into initiation and secondary mechanisms. Thereafter, their quantity-effect relationship was speculated. These helped deepen the understanding of the time association and the crosstalk mechanisms.
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REVIEW ARTICLES Top
P. 23
Mauro Gori, Emilia D'Elia, Michele Senni
DOI:10.4103/2470-7511.312591  
Sacubitril/valsartan (S/V) is a new drug which has been recently recommended by the international guidelines for the treatment of patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF). Compared to angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), S/V is associated with a better cardiovascular outcome, and to a greater beneficial effect on myocardial reverse remodeling. Recent evidence has shown that S/V is not only recommended in chronic patients but it is also approved in the acute setting; moreover, its safety and tolerability have been demonstrated also in the pediatric population. This review summarizes data on the effectiveness and tolerability of S/V in HFrEF patients and offers practical insights to manage this drug in every setting, providing an overview from randomized clinical trials' data to real-world evidence.
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P. 30
Bing-Yin Wang, Bin-Quan You, Feng Liu
DOI:10.4103/2470-7511.312592  
Coronavirus disease 2019 (COVID-19) has spread, at an unprecedented speed and scale, into a global pandemic, infecting more than 29 million cases worldwide across 215 countries and territories and killing more than 930,000 individuals. There is evidence that preexisting cardiac disease can render individuals vulnerable. A large number of patients with COVID-19 present with preexisting cardiovascular disease or develop new-onset cardiac dysfunction during the course of the illness. Therefore, particular attention should be given to cardiovascular protection during COVID-19 treatment. This review highlights recent advances in our understanding of the interaction between COVID-19 and the cardiovascular system, with special attention to the virological, pathological, and immunological characteristics of COVID-19, acute myocardial injury, myocarditis, arrhythmias, coronary artery disease, heart function, and the possible mechanisms.
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P. 41
Yi-Qiong Zhang, Yi-Ming Hua, Chen-Xing Li, Bei-Di Lan, Xiao-Ke Wang, Qi Wang, Zu-Yi Yuan, Lu Ma, Yue Wu
DOI:10.4103/2470-7511.312593  
Numerous studies unveiled the interactions between intestinal flora and the host and how these affect human health and disease. The gut microbiota and its metabolites, such as trimethylamine N-oxide (TMAO), short-chain fatty acids, and secondary bile acids, are related to human metabolism, immunity, and diseases. An increasing number of studies has indicated that intestinal flora and its metabolites contribute to cardiovascular diseases (CVDs) development. Revealing the role of intestinal flora and its metabolites in cardiovascular pathogenesis may provide novel strategies for preventing and treating CVDs. However, the specific mechanisms are unclear, and more research is warranted. Here, we reviewed the most recent research progress on the relationship between intestinal flora, its metabolites, and CVDs.
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ORIGINAL ARTICLES Top
P. 48
Yu-Yao Ji, Siang Wei, Ran Xu, Run-Da Wu, Kang Yao, Yun-Zeng Zou
DOI:10.4103/2470-7511.312597  
Objectives: The aim of this study was to identify differentially expressed genes (DEGs) related to myocardial infarction (MI), which may serve as research and therapeutic targets. Methods: MI expression profiles were obtained from the Gene Expression Omnibus (GEO) database. DEGs were screened using GEO2R, and DEGs in multiple datasets were identified using Venn diagrams. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment analyses were performed using the Database for Annotation, Visualization, and Integrated Discovery v6.8. A protein-protein interaction (PPI) network was constructed using STRING and Cytoscape 3.7.2. Coexpedia was used for gene coexpression network analysis and functional annotation. Results: We identified 50 DEGs in the four datasets, including 29 with important roles in the PPI network. GO functional enrichment analysis revealed the involvement of DEGs in biological processes such as cytokine activation, peptidase inhibition, and chemokine activation. KEGG analysis revealed enrichment in chemokine signaling and cytokine-cytokine receptor interactions. Gene coexpression network analysis identified nine hub genes involved in the occurrence and development of MI including tissue inhibitor of metalloproteinase 1; CD44 antigen; lysyl oxidase; formyl peptide receptor 2; matrix metallopeptidase 3; formyl peptide receptor 1; serine (or cysteine) peptidase inhibitor, clade E, member 1; prostaglandin-endoperoxide synthase 2; and elastin. Conclusions: The hub genes identified may play important roles in MI-related biological processes and represent potential diagnostic and therapeutic targets. Therefore, this study lays a foundation for further exploration of the molecular mechanisms of MI.
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P. 56
Sheng-Qi Ma, Jin-Hua Zhu, Lei Wu, Yan He, Li-Yun Ren, Bin Shen, Jia Yu, Rong-Yan Zhang, Jing Li, Ming-Zhi Zhang, Hao Peng
DOI:10.4103/2470-7511.312596  
Objectives: Furin has been associated with hypertension through unclear underlying mechanisms. FURIN promoter methylation may participate in the underlying mechanisms, but no evidence supports this possibility. Here, we performed a prospective analysis to study the association between FURIN promoter methylation and incident hypertension. Methods: DNA methylation levels in the FURIN promoter were quantified by target bisulfite sequencing using peripheral blood from 1043 participants in the Gusu cohort (mean age: 50 years, 30% men) who were free of hypertension at baseline. After an average of 4 years of follow-up, 149 (14.3%) participants developed hypertension. Multiple testing was controlled for by measuring the false-discovery rate. Results: Of the eight CpG loci assayed, DNA methylation levels at Chr15: 91416118 were significantly associated with incident hypertension after adjusting for covariates and multiple testing (hazard ratio [HR] = 1.38, 95% confidence interval [CI]: 1.17–1.64, q = 0.001). The weighted truncated-product method, which combines single CpG associations, revealed that DNA methylation at multiple CpG sites was jointly associated with incident hypertension (P < 0.001). Using the average methylation level of all CpG sites as a surrogate for FURIN promoter methylation revealed a similar association (HR = 1.36, 95% CI: 1.08–1.72, P = 0.009). Almost all CpG methylations negatively correlated with serum furin levels, which mediated approximately 29.44% of the association between FURIN promoter methylation and incident hypertension. Conclusions: These results suggest that FURIN promoter hypermethylation is associated with an increased risk for hypertension in Chinese adults, partially through suppressing furin expression or excretion.
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STUDY DESIGN Top
P. 65
Shali Shalaimaiti, Yu-Xiang Dai, Hong-Yi Wu, Ju-Ying Qian, Yan Zheng, Kang Yao, Jun-Bo Ge
DOI:10.4103/2470-7511.312594  
Background: Emerging evidence indicates that the worldwide incidence of early-onset coronary artery disease (EOCAD) is increasing. The genetic background has been assumed to harbor pathogenic risk, although the existing findings are mainly restricted to Caucasians. Little is known regarding the clinical profiles of patients with EOCAD and the extent to which genetic factors are related to disease susceptibility and outcomes in Asian people, especially ethnic Chinese. Methods and Results: The Genetic characteristics of coRonary Artery disease (CAD) in ChiNese young aDults (GRAND) study is a multicenter, hospital-based observational clinical study, combined of case-control design and longitudinal prospective cohort. Six thousand nationally representative patients who underwent coronary angiography at 38 centers have been enrolled since May 2017. Clinical data of patients with EOCAD (aged ≤45 years) are collected at the baseline to delineate conventional risk factors, clinical profiles, and therapeutic options of EOCAD and compared with data for patients with late-onset CAD (aged ≥65 years) and age-matched controls without CAD. The patients are followed for 3 years to trace major adverse cardiovascular (CV) events: cardiac death, nonfatal myocardial infarction, and ischemia-driven revascularization. Functional variants contributing to EOCAD risk are identified by high-depth whole-exome sequencing. The genetic profiles are further linked to disease severity and prognosis. A multi-dimensional risk score is established to predict prevalent EOCAD and incident CV events among young Chinese adults. Conclusions: The GRAND study will generate a thorough understanding of the clinical characteristics and genetic basis of EOCAD and may pave the way for genetic screening, early prevention, and future drug discovery for CAD in young Chinese generations.
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TRAINING COURSE Top
P. 73
Siew Yen Ho
DOI:10.4103/2470-7511.312599  
The four heart valves are arranged in different planes from each other. The aortic valve is most centrally located being related to all four cardiac chambers. Similar in construction to the pulmonary valve in possessing semilunar leaflets, neither valve has a ring-like annulus. Instead, the semilunar insertions of the leaflets form a crown-like arrangement. The semilunar valves are complexes comprising not only of leaflets but their attachments to arterial walls and adjoining ventricular structures at the ventriculo-arterial junction. The mitral and tricuspid valves guarding the atrioventricular junctions comprise of leaflets hinged to the junction, and have tendinous cords mainly anchored to papillary muscles that are inserted into ventricular walls to the support apparatus. A complete fibrous annulus is lacking, especially in the tricuspid valve and along the hinge line of the posterior mitral leaflet. This article also reviews the relationships of each valvar component and to adjacent cardiac structures.
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