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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.

Rupture of the sinus of Valsalva is an extremely rare complication of percutaneous coronary intervention. It could lead to lethal sequelae if not coded properly. We experienced a rupture of sinus of Valsalva during the percutaneous coronary intervention which led to pericardial tamponade, causing hemodynamic instability. Surgery was performed immediately, and the patient was discharged without symptoms. Manipulation of the guiding catheter should be performed with great caution during the whole procedure, especially in patients with hypertension, atherosclerosis, or other diseases.

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.

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.

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.

Online since 8^th January 2018