Higher serum angiopoietin 2 levels are independently associated with coronary microvascular dysfunction in patients with angina in the absence of obstructive coronary artery disease / 中华医学杂志(英文版)

BACKGROUND@#Angiopoietin-2 (Ang-2) is a type of endothelial growth factor involved in angiogenesis and vascular remodeling. Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease (CAD). This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.@*METHODS@#A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study. Coronary flow reserve (CFR) was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography. The patients were divided into the following two sub-groups according to CFR: the impaired CFR group with CFR values <2.5 and the preserved CFR group with CFR values ≥2.5. Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay. Independent predictors for impaired CFR were identified by binary logistic regression analysis. The receiver-operating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.@*RESULTS@#We found that age, percentage of female sex, N-terminal pro-B-type natriuretic peptide levels, Ang-2 levels (763.3 ± 264.9 vs. 579.7 ± 169.3 pg/mL, P < 0.001), and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR. Serum Ang-2 levels were negatively correlated with CFR (r = -0.386, P < 0.001). Binary logistic regression analysis showed that Ang-2 (odds ratio: 1.004, 95% confidence interval [CI]: 1.001-1.006, P = 0.003) and age (odds ratio: 1.088, 95% CI: 1.023-1.156, P = 0.007) were independently associated with impaired CFR. Furthermore, Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve (P < 0.001). The area under the curve was 0.712 (95% CI: 0.612-0.813).@*CONCLUSIONS@#High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.

Impact of uncontrolled blood pressure on diagnostic accuracy of coronary flow reserve for detecting significant coronary stenosis in hypertensive patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Impaired coronary flow reserve (CFR) in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary microvascular dysfunction. The aim of this study was to evaluate the impact of uncontrolled blood pressure (BP) on diagnostic accuracy of CFR for detecting significant coronary stenosis.</p><p><b>METHODS</b>A total of 98 hypertensive patients scheduled for coronary angiography (CAG) due to chest pain were studied. Of them, 45 patients had uncontrolled BP (defined as the office BP ≥ 140/90 mmHg (1 mmHg = 0.133 kPa) in general hypertensive patients, or ≥ 130/80 mmHg in hypertensive individuals with diabetes mellitus), and the remaining 53 patients had well-controlled BP. CFR was measured in the left anterior descending coronary artery (LAD) during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography (TTDE) within 48 hours prior to CAG. Significant LAD stenosis was defined as > 70% luminal narrowing. Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis.</p><p><b>RESULTS</b>CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP (2.1 ± 0.6 vs. 2.6 ± 0.9, P < 0.01). Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis (β = -0.445, P < 0.0001) and the presence of uncontrolled BP (β = -0.272, P = 0.014). With a receiver operating characteristic analysis, CFR < 2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients (AUC 0.83, 95%CI 0.75 - 0.91) with a sensitivity of 75%, a specificity of 78%, and an accuracy of 77%. A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP (67% vs. 93%, P = 0.031).</p><p><b>CONCLUSIONS</b>CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients. However, the diagnostic specificity is reduced in patients with uncontrolled BP.</p>

Value of left atrial area index for diagnosing left ventricular diastolic dysfunction in hypertensive patients with preserved left ventricular systolic function / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the correlation between left atrial size and left ventricular filling pressure (LVFP) and the value of left atrial size assessment on detecting diastolic dysfunction in hypertensive patients with preserved LVEF by echocardiography.</p><p><b>METHODS</b>Echocardiography was performed in 346 hypertensive patients with preserved LVEF(≥ 50%), left atrial size including left atrial diameter (LAD) and left atrial area (LAA) was measured and indexed to body surface area (LADI, LAAI). The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) was determined and LVFP was calculated with the formula: LVFP = 1.24×E/Em + 1.9. Patients were divided into diastolic dysfunction group [DD group, LVFP > 15 mm Hg (1 mm Hg = 0.133 kPa), n = 81] and normal diastolic function group (NDF group, LVFP ≤ 15 mm Hg, n = 265).</p><p><b>RESULTS</b>As compared to patients in NDF group, the patients in DD group had larger LA [LADI: (21.4 ± 2.6) mm/m(2) vs. (19.6 ± 2.4) mm/m(2); LAAI: (12.1 ± 2.6) cm(2)/m(2) vs. (10.4 ± 1.7)cm(2)/m(2); all P < 0.01]. LA size parameters were positively correlated with LVFP (r = 0.211-0.450, all P < 0.01), LAAI was best correlated with LVFP (r = 0.450, P < 0.01). ROC analysis showed that LAAI ≥ 11.4 cm(2)/m(2) diagnosed DD with a sensitivity of 63%, specificity of 74% and accuracy of 72%.</p><p><b>CONCLUSION</b>Left atrium dilation correlates positively with LVFP in hypertensive patients with preserved LVEF. The LAAI is a more accurate parameter for identifying patients with diastolic dysfunction in this cohort.</p>

Current status of morning blood pressure control and medication of hypertensive patients in Beijing / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the current status of morning blood pressure and medication of hypertensive patients in Beijing.</p><p><b>METHODS</b>This study included 2187 hypertensive patients who visited the ambulance of our cardiology department in the morning (7:00-10:00) from March 2012 to April 2012. Patients were divided into three groups: no antihypertensive agent group, single antihypertensive drug therapy group (include CCB, ARB, ACEI, β-blocker) and combined drug therapy group at least one month. Blood pressure control rate was compared among the groups.</p><p><b>RESULTS</b>Target blood pressure was not reached in 1193 patients (54.6%), most patients took CCB and the target blood pressure was not reached in 61.7% (295/478) patients taking CCB. There was no significant difference on target blood pressure uncontrolled rate among the four single drug subgroups (CCB, ARB, ACEI, β-blocker). The blood pressure uncontrolled rate was 46.3% (63/136) for amlodipine, 70.5% (55/78) for nifedipine and 73.8% (31/42) for felodipine. There OR of uncontrolled blood pressure rate was 0.36 (amlodipine vs. nifedipine, 95%CI:0.20-0.65) and 0.31% (amlodipine vs. felodipine, 95%CI:0.14-0.66).</p><p><b>CONCLUSION</b>The morning blood pressure uncontrolled rate is high in hypertensive patients visiting Beijing tertiary hospitals. Amlodipine is possible superior to nifedipine and felodipine on morning blood pressure control in this patient cohort.</p>

Left ventricular flow vector characteristics and the relationship between flow vector and left ventricular systolic function in patients with anterior myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess left ventricular vortex and flow vector features and the relationship between vector flow and left ventricular systolic function in patients with anterior myocardial infarction by echocardiography-derived vector flow mapping (VFM).</p><p><b>METHODS</b>Echocardiography was performed in 31 patients with anterior myocardial infarction and 20 healthy controls. Flow vector and velocity of left ventricle were analyzed on apical 3 chambers view with color Doppler.</p><p><b>RESULTS</b>(1) Left ventricular intracavitary vortex during isovolumic contraction phase could be detected in both groups. Vortex was detectable also during contraction phase and relaxation phase in patients with myocardial infarction. There was no vortex during contraction phase, and there was only small and transit vortex during relaxation phase in control group. (2)Flow vector of apex and middle segments directed to apex and was opposite to that of basal segment of left ventricle in patients with myocardial infarction and in controls [(10.6 ± 8.3) cm/s vs. -(5.8 ± 7.2) cm/s, (19.5 ± 11.8) cm/s vs. -(16.6 ± 14.7) cm/s]. During rapid relaxation phase, the velocity in apex was lower in patients with myocardial infarction than that in control group [(6.8 ± 9.8) cm/s vs. (17.6 ± 15.8) cm/s, P < 0.01]. (3) There was a negative correlation between velocity in apex and left ventricular ejection fraction (LVEF) during rapid eject phase in patients with anterior myocardial infarction (r = -0.52, P < 0.05). Velocity in apex of patients with LVEF < 50% was higher than that of patients with LVEF ≥ 50% during rapid eject phase [(13.5 ± 9.0) cm/s vs. (5.8 ± 5.1) cm/s, P < 0.05].</p><p><b>CONCLUSIONS</b>Vortex period is prolonged in patients with anterior myocardial infarction compared to normal controls during whole cardiac cycle, flow vector of apex and middle segments is directed to apex during eject phase and there is a negative correlation between velocity in apex and LVEF during rapid eject phase in patients with anterior myocardial infarction.</p>

Churg-Strauss syndrome in children: a case evolving in endomyocardiopathy / 中国当代儿科杂志

A 13-year-old girl presented with a 1-month history of progressive exertional dyspnea (NYHA class IV) and exophthalmos for 6 months. She had a history of long-standing asthma and the presence of allergy. Hypereosinophilia and increased serum IgE levels (2472 IU/mL) were observed. Chest radiography and a high resolution CT scan documented a massive interstitial pulmonary infiltration. Echocardiography confirmed mild tricuspid regurgitation, apical obliteration of the right ventricle by fibrocalcific thickening of the endocardium and echogenic material suggestive of thrombosis. Churg-Strauss syndrome with cardiac involvement (endomyocardiopathy) was diagnosed. The patient received anticoagulation and corticosteroid therapy. In view of rapidly progressive severe endomyocardiopathy and stable hematology, the patient was referred for cardiac surgery. Histopathological examination of resected specimens confirmed laminated thrombus but without any trace of eosinophils embedded.

The mechanism of stem cell factor in bone marrow stem cell transplantation to heart / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the mechanism of stem cell factor (SCF) in bone marrow stem cells heart transplantation (BMT) and the influence of bone marrow mobilization on the transplantation efficacy.</p><p><b>METHODS</b>Rats with acute myocardial infarction (AMI) accepted BMT. The SCF expression in the bone marrow was measured by RT-PCR after the operation. Then bone marrow stem cells with different SCF levels for the transplantation were used and the cardiac function was compared by using echocardiography. The SCF protein expression in the heart, plasma and bone marrow was detected by ELISA.</p><p><b>RESULTS</b>SCF expression level decreased significantly 1 week after AMI (P < 0.01), but it didn't decrease in those accepting BMT. Though the rats accepted BMT with bone marrow stem cells from different sources, the cardiac function showed no difference (P > 0.05). After BMT, the SCF protein level in the plasma decreased significantly (P < 0.05).</p><p><b>CONCLUSIONS</b>BMT may make mobilization through SCF. Bone marrow stem cells from rats with AMI and also those with myocardial infarction plus BMT therapy can also be used for the transplantation into heart, and have no influence on cardiac function improvement.</p>

Comparison of changes in left ventricular gene expression profiles from different cardiac hypertrophy models in rats / 生理学报

To get insights into the principles of gene expression changes during cardiac hypertrophy, three rat cardiac hypertrophy models were prepared, i.e., suprarenal abdominal aortic stenosis (SRS), arterial-vein fistula (AVF) and continuous jugular vein infusion of norepinephrine (NEi). The cardiac function and structure were analyzed by echocardiograph as well as histological examination. Total RNA of left ventricles was extracted and gene expression profiles were analyzed by cDNA microarray. SRS and NEi induced concentric cardiac hypertrophy and AVF induced eccentric hypertrophy in rats, among which NEi caused obvious cardiac fibrosis. The changes of gene expression profiles were compared comprehensively across different pathologic cardiac hypertrophy models. While gene expression profiles of different cardiac hypertrophy models compared with pairs, parts of the genes involved were found overlapped, and mostly the gene expression changed in the same direction between two models, but some of them changed in the opposite directions. Expression levels of 19 genes were found changed across all cardiac hypertrophy models, and genes relatively regulated in a specific model was also found when comparison of all the three models was carried out. Novel clues for further study might derive from the results mentioned above, and some genes might be the marker genes of cardiac hypertrophy or the targets of therapy.

Alterations of Axin protein expression during cardiac remodeling in rats / 生理学报

The purpose of the present study was to observe the expression of Axin protein during cardiac remodeling in rats. Cardiac remodeling animal models were prepared with the methods of jugular venous norepinephrine (NE)-infusion or arterial-vein fistula (AVF). The ultrasonic parameters of rat hearts were recorded before sacrifice. The expressions of Axin protein were determined by Western blot in rat hearts from different remodeling models as well as cultured cardiac fibroblasts from adult rats. Cardiac concentric hypertrophy and fibrosis was induced by 3-day jugular vein infusion of NE in rats. The expression of Axin in the left ventricles increased significantly compared with that of the control group. Cardiac eccentric hypertrophy without fibrosis was induced by A-V fistula for one week in rats, and no change in Axin protein expression in the left ventricles was observed. In cultured adult rat cardiac fibroblasts, NE treatment for 24 h increased significantly the Axin protein level. It is therefore concluded that Axin protein was expressed in rat heart and increased significantly in left ventricles during NE-induced rat cardiac remodeling, which may be relevant to cardiac fibrosis.