Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19 / 中华心血管病杂志

Objective: To evaluate the cardiovascular damage of patients with COVID-19, and determine the correlation of serum N-terminal pro B-type natriuretic peptide (NT-proBNP） and cardiac troponin-I (cTnI） with the severity of COVID-19, and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated. Methods: A cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January 19 to February 13 in 2020, including 126 mild cases and 24 cases in critical care. Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension, diabetes and coronary heart disease (CHD）, as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients. Results: Age, hypersensitive C-reactive protein(hs-CRP) and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05). Prevalence of male, elevated NT-proBNP and cTnI, hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05). Univariate logistic regression analysis showed that age, male, elevated NT-proBNP, elevated cTnI, elevated hs-CRP, elevated serum creatinine, hypertension, and CHD were significantly correlated with critical disease status(all P<0.05). Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909，95%CI 4.086-177.226，P=0.001) and CHD (OR=16.609，95%CI 2.288-120.577，P=0.005) were the independent risk factors of critical disease status. Conclusions: COVID-19 can significantly affect the heart function and lead to myocardial injury. The past medical history of CHD and increased level of cTnI are 2 independent determinants of clinical disease status in patients with COVID-19.

Global Longitudinal Strain at Rest for Detection of Coronary Artery Disease in Patients without Diabetes Mellitus / 华中科技大学学报（医学）（英德文版）

Global longitudinal strain (GLS) at rest on two-dimensional speckle tracking echocardiography (2D STE) was demonstrated to help detect coronary artery disease (CAD).However,the optimal cut-off point of GLS and its diagnostic power for detecting critical CAD in non-diabetes mellitus (DM) patients are unknown.In the present study,211 patients with suspected CAD were prospectively included,with DM patients excluded.All patients underwent echocardiography and subsequently coronary angiography within 3 days.Left ventricular (LV) GLSs were quantified by 2D STE.Territorial peak systolic longitudinal strains (TLSs) were calculated based on the perfusion territories of the 3-epicardial coronary arteries in a 17-segment LV model.Critical CAD was defined as an area stenosis ≥70％ in ≥1 epicardial coronary artery (≥50％ in left main coronary artery).Totally 145 patients were diagnosed as having critical CAD by coronary angiography.Significant differences were observed in all strain parameters between patients with and without critical CAD.The area under the receiver operating charcteristic (ROC) curve (AUC) for GLS in the detection of left main (LM) or threevessel CAD was 0.875 at a cut-off value of-19.05％ with sensitivity of 78.1％ and specificity of 72.7％,which increased to 0.926 after exclusion of apical segments (cut-off value-18.66％;sensitivity 84.4％ and specificity 81.8％).The values of TLSs were significantly lower in regions supplied by stenotic arteries than in those by non-stenotic arteries.The AUC for the TLSs to identify critical stenosis of left circumflex (LCX) artery,left anterior descending (LAD) artery and right coronary artery (RCA),in order of diagnostic accuracy,was 0.818 for LCX,0.764 for LAD and 0.723 for RCA,respectively.In conclusion,in non-DM patients with suspected CAD,GLS assessed by 2D STE is an excellent predictor for LM or three-vessel CAD with high diagnostic accuracy,and a higher cut-off point than reported before should be used.Excluding apical segments in the calculation of GLS can further improve the predictive accuracy of GLS.It is unsatisfactory for TLSs to be used to identify stenotic coronary arteries.

Global Longitudinal Strain at Rest for Detection of Coronary Artery Disease in Patients without Diabetes Mellitus / 华中科技大学学报（医学）（英德文版）

Global longitudinal strain (GLS) at rest on two-dimensional speckle tracking echocardiography (2D STE) was demonstrated to help detect coronary artery disease (CAD).However,the optimal cut-off point of GLS and its diagnostic power for detecting critical CAD in non-diabetes mellitus (DM) patients are unknown.In the present study,211 patients with suspected CAD were prospectively included,with DM patients excluded.All patients underwent echocardiography and subsequently coronary angiography within 3 days.Left ventricular (LV) GLSs were quantified by 2D STE.Territorial peak systolic longitudinal strains (TLSs) were calculated based on the perfusion territories of the 3-epicardial coronary arteries in a 17-segment LV model.Critical CAD was defined as an area stenosis ≥70％ in ≥1 epicardial coronary artery (≥50％ in left main coronary artery).Totally 145 patients were diagnosed as having critical CAD by coronary angiography.Significant differences were observed in all strain parameters between patients with and without critical CAD.The area under the receiver operating charcteristic (ROC) curve (AUC) for GLS in the detection of left main (LM) or threevessel CAD was 0.875 at a cut-off value of-19.05％ with sensitivity of 78.1％ and specificity of 72.7％,which increased to 0.926 after exclusion of apical segments (cut-off value-18.66％;sensitivity 84.4％ and specificity 81.8％).The values of TLSs were significantly lower in regions supplied by stenotic arteries than in those by non-stenotic arteries.The AUC for the TLSs to identify critical stenosis of left circumflex (LCX) artery,left anterior descending (LAD) artery and right coronary artery (RCA),in order of diagnostic accuracy,was 0.818 for LCX,0.764 for LAD and 0.723 for RCA,respectively.In conclusion,in non-DM patients with suspected CAD,GLS assessed by 2D STE is an excellent predictor for LM or three-vessel CAD with high diagnostic accuracy,and a higher cut-off point than reported before should be used.Excluding apical segments in the calculation of GLS can further improve the predictive accuracy of GLS.It is unsatisfactory for TLSs to be used to identify stenotic coronary arteries.

Throat infection, neck spinal disease, chest pain and cardiac response: a new clinical syndrome? / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of a new clinical syndrome, including throat infection, neck spinal disease, chest pain and cardiac response.</p><p><b>METHODS</b>A total of 165 patients with above mentioned symptoms admitted to Tongji hospital from 2003 to 2005 were included in this study and underwent further medical history inquiry, physical examination and laboratory tests. Eighty-five healthy subjects served as controls. Serum myocardial auto-antibodies against beta(1)-adrenoceptor, alpha-myosin heavy chain, M(2)-muscarinic receptor and adenine-nucleotide translocator were detected, inflammatory cytokines, high sensitivity C-reaction protein, serum antibodies against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae were determined and lymphocyte subclasses were assayed by flow cytometry.</p><p><b>RESULTS</b>All patients had a complex of four symptoms or tetralogy: (1) persistent throat or upper respiratory tract infection; (2) neck pain; (3) chest pain; (4) chest depression or dyspnea, some of them with anxiety. Anti-myocardial auto-antibodies (AMCA) were present in all patients vs. 8% in controls. TNF-alpha, IL-1 and IL-6 were significantly higher in patients than controls (P < 0.01). CD3(+) and CD4(-)CD8(+) lymphocytes were significantly higher and CD56(+) lymphocytes lower in patients than those in controls (P < 0.01). The ratios of serum pathogen antibodies positive against Coxsackie virus-B, cytomegalovirus, Mycoplasma pneumoniae and Chlamydia pneumoniae were all significantly higher in patients than in controls.</p><p><b>CONCLUSIONS</b>These data led to identification of a persistent respiratory infection-related clinical syndrome, including persistent throat infection, neck spinal lesion, rib cartilage inflammation, symptoms of cardiac depression and dyspnea with or without anxiety.</p>

Impact of growth-factor hormone control on the outcome of acromegalic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the impact of growth-factor hormone control on the outcome of acromegalic cardiomyopathy by reviewing cases from our own center and from literatures.</p><p><b>METHODS</b>Two cases of acromegalic cardiomyopathy from Tongji hospital and 29 acromegalic cardiomyopathy cases with fully accessible data retrieved from PubMed and CNKI websites were included in present study for analysis. They were divided into "Controlled (< 5 microg/L)" or "Uncontrolled" group according to the serum level of growth factor hormone after treatments. Outcome of patients was evaluated by symptom, NYHA class, LV size and function status.</p><p><b>RESULTS</b>Incidence of patients with improved symptoms and cardiac performance was significantly higher in "Controlled" group (18/19) compared to those in "Uncontrolled" group (0/12; P < 0.01, chi(2) = 27.1). Post-treatment growth-factor hormone level < 5 microg/L is significantly associated with a satisfactory outcome of acromegalic cardiomyopathy (r = 0.935, P < 0.01).</p><p><b>CONCLUSIONS</b>Control of serum growth-factor concentration to a value < 5 microg/L is critical and associated with a favorable outcome for patients with acromegalic cardiomyopathy.</p>

Aldosterone/plasma renin activity ratio is a sensitive parameter for screening patients with primary aldosteronism / 中华心血管病杂志

<p><b>OBJECTIVE</b>To screen primary aldosteronism cases with ARR (aldosterone/plasma renin activity, ARR) from patients with hypertension, and to evaluate the diagnosis value of ARR in primary aldosteronism cases and analysis the clinical characters of primary aldosteronism cases.</p><p><b>METHODS</b>Nine hundred and two patients with hypertension were collected, the plasma aldosterone concentration to plasma renin activity ratio were detected by radio-immunity method, after that, ARR were calculated. Retrospective analysis was made of clinical data in 126 primary aldosteronism cases, which ARR were over 25.</p><p><b>RESULTS</b>One hundred and twenty-six cases (14%) were diagnosed as primary aldosteronism, and of them, 49 cases had hypokalemia. 25 patients received surgical operation and the rate of efficiency and cure of surgery treatment were 100% and 48%, respectively. The rate of efficiency and cure of drug treatment was 89% and 24% respectively.</p><p><b>CONCLUSIONS</b>Primary aldosteronism affects over 10% of patients with hypertension in China. Patients with hypertension and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism with ARR. A high ARR is a positive screening test result, a finding that warrants confirmatory testing.</p>

The relationship between microalbuminuria and plasma high sensitivity C reactive protein / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between microalbuminuria (MA) and plasma high sensitivity C reactive protein (hsCRP).</p><p><b>METHOD</b>The plasma hsCRP level and urine albumin level of 746 Chinese people were detected with ELISA and analyzed, respectively.</p><p><b>RESULT</b>The hsCRP level of MA group increased significantly compared with the control group (2.23 +/- 3.35 mg/L vs 1.68 +/- 2.58 mg/L, P < 0.05), the incidence of MA increased significantly when the plasma hsCRP level was beyond 0.77 mg/L (P < 0.05); logistic analysis showed that the occurrence of MA was associated with the plasma hsCRP level (OR = 1.153, P < 0.05).</p><p><b>CONCLUSION</b>Increased plasma hsCRP was probably involved in the occurrence of MA, suggesting that inflammation may deteriorate endothelial dysfunction.</p>

Study on the distribution of serum homocysteine and on multi-stepwise regression analysis of the associated factors in the population of community areas in Wuhan / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the serum homocysteine (Hcy) distribution and characteristics in different sex and age groups in the community residents in Wuhan, and to analyse its associated factors with multi-stepwise regression analysis.</p><p><b>METHODS</b>The population under study was from three community areas in Wuhan. Demographic distribution and the correlation with other risk factors of serum Hcy were analyzed statistically.</p><p><b>RESULTS</b>(1) Geometric mean of serum Hcy was 14.43 micromol/L in males and 10.89 micromol/L in females with P <0.001. (2) Hcy of per age level in males was also higher (P <0.001). (3) The prevalence rate of hyperhomocysteinemia was 23.94% in the general population in Wuhan. The prevalence rate of hyperhomocysteinemia in males was 2.62 times higher than in females. (4) Multi-stepwise regression analysis showed that Hcy had different affecting factors in males and females. The affecting factors of Hcy in males were daily cigarettes smoking, urine micro-albumin (UMALB) and times of exercise per week. The affecting factors of Hcy in females were duration of exercise each time, weight, triglyceride (TG), high-density lipoprotein (HDL), urine micro-albumin (UMALB) and age.</p><p><b>CONCLUSIONS</b>(1) Hcy at the population level was significantly different by sex and age. (2) Population living in the community in Wuhan had a higher serum level and prevalence rate of Hcy comparing to some other cities in China and even in developed countries. (3) The important affecting factors of Hcy in population also showed sex difference, unlike the reports from other countries or other areas in China. Serum Hcy seemed to be affected by environmental and other factors.</p>

A case-control study on the relationship between stroke and plasma homocysteine level and the mutation of MTHFR gene / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the relationship of stroke and plasma homocysteine (Hcy) level and the mutation of methylenetetrahydrofolate reductase (MTHFR) gene.</p><p><b>METHODS</b>Three hundred patients with stroke were included as the case group in this study while 300 subjects without stroke matched with the case group for sex and age were collected as the control group. Plasma Hcy level was measured using HPLC and MTHFR 667C-->T mutant was determined by polymerase chain reaction and restriction fragment analysis. The relationship of stroke and plasma Hcy level and the mutation of MTHFR gene was then analysed.</p><p><b>RESULTS</b>The plasma Hcy level of the case group was significantly higher than that of the control group (16.92 +/- 3.43 micromol/L vs. 14.57 +/- 2.59 micromol/L, P <0.05). There was no significant difference in mutation rate of MTHFR C677T between stroke group and control group (P >0.05), as well as between ischemic stroke group and homorrhagic stroke group (P >0.05). The mutation of MTHFR C677T had no significant influence on the Hcy level (15.28 +/- 2.17 micromol/L vs. 15.11 +/- 3.81 micromol/L, P >0.05).</p><p><b>CONCLUSION</b>Increased plasma Hcy level played an important role in the occurrence of stroke in Chinese people, and the mutation of MTHFR C677T was not associated with Hcy level or stroke which led to the speculation that plasma Hcy level was important in the prevention of cardio-cerebro-vascular diseases among Chinese people.</p>