Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI). Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI), and thus, we attempt to assess this relationship and its potential short-term prognostic value.</p><p><b>METHODS</b>This was a single-center, observational, retrospective cohort study. A total of 513 consecutive patients (399 men, 114 women) with NSTEMI within 24 h who underwent coronary angiography at our department, between January 1, 2014, and December 31, 2014. Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG. fQRS complexes were defined as the existence of an additional R' or crochetage wave, notching in the nadir of the S wave, RS fragmentation, or QS complexes on 2 contiguous leads. All patients were followed up for 6 months, and all major adverse cardiac events (MACE) were recorded.</p><p><b>RESULTS</b>In this study, there were 285 patients with fQRS ECG in the 513 patients with NSTEMI. The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P = 0.042). There were fewer Killip Class I patients in the fQRS group (P = 0.019), while Killip Class II, III, and IV patients were more in the fQRS group than in the non-fQRS group (P = 0.019). Left ventricular ejection fraction levels were significantly lower in the fQRS group (P = 0.021). Baseline total cholesterol, low-density lipoprotein, creatinine, creatine kinase, homocysteine, high-sensitivity C-reactive protein (CRP), and red blood cells distribution width levels were significantly higher in the fQRS group. Total MACE (MACE, P = 0.028), revascularization (P = 0.005), and recurrent angina (P = 0.005) were also significantly greater in the fQRS group. On final logistic regression analysis, after adjusting for baseline variables, the following variables were independent predictors of fQRS: Coronary artery narrowing (P = 0.035), Killip classification (P = 0.026), and total cholesterol (P = 0.002). The following variables were found to be independent predictors of preoperative MACE: Hemoglobin (P = 0.000), gender (P = 0.026), fQRS (P = 0.016), and time from myocardial infarction to balloon or coronary artery bypasses grafting (P = 0.013).</p><p><b>CONCLUSIONS</b>The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients. The number of narrowed coronary arteries, Killip classification, and total cholesterol are all independent predictors of the fQRS complexes.</p>

Change in cholesterol absorption and synthesis markers in patients with coronary heart disease after combination therapy with simvastatin plus ezetimibe / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Statins and ezetimibe have been reported to change the balance of cholesterol metabolism, but few studies have been performed on Chinese patients. The aim of this study was to evaluate changes in cholesterol metabolism markers in patients with coronary heart disease.</p><p><b>METHODS</b>Forty-five patients with coronary heart disease were treated with 20 mg/d of simvastatin for four weeks. Subjects were then divided into two different therapy groups according to whether they reached the target values for total cholesterol and low density lipoprotein cholesterol level. Patients who reached the target values remained on simvastatin and those who did not reach the target values took a combination of simvastatin plus 10 mg/d ezetimibe until the 12th week. The concentrations of cholesterol synthesis markers (lathosterol and desmosterol) and absorption markers (campesterol and sitosterol) were measured on the 1st, 4th, and 12th week of the study by gas chromatography.</p><p><b>RESULTS</b>After treatment with simvastatin for four weeks, the levels of total cholesterol and low density lipoprotein cholesterol decreased significantly compared to levels measured during the 1st week (P < 0.05). On the 12th week the levels of total cholesterol and low density lipoprotein cholesterol had decreased significantly (P < 0.001) compared to levels during the 4th week. By the 12th week the levels of campesterol and sitosterol in the combination group had decreased significantly (P < 0.05) compared with levels measured during the 4th week.</p><p><b>CONCLUSIONS</b>Coronary heart disease patients with high cholesterol synthesis at baseline might gain a greater benefit from simvastatin treatment. Combination therapy with simvastatin plus ezetimibe in patients with low cholesterol synthesis at baseline might increase the success rate of lipid-lowering through decreasing the absorption of cholesterol.</p>

Impact of anemia on long-term outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary interventions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the impact of pre-procedure anemia on the long-term mortality in elderly patients with acute coronary syndrome (ACS) after percutaneous coronary interventions.</p><p><b>METHODS</b>A total of 1014 ACS patients (≥ 60 years of age) with hemoglobin data and without previous treatment with thrombolytic agents and without end-stage renal failure before the interventional procedure were included. Patients were classified as anemia using the definition of World Health Organization: hemoglobin < 130 g/L in men, and < 120 g/L in women. A total of 253 patients were anemia. The clinical features of patients with and without anemia and association of pre-procedure anemia with long-term mortality were analyzed.</p><p><b>RESULTS</b>Incidence of diabetes and serum creatinine level were significantly higher in anemia patients than in non-anemia patients while systolic blood pressure and low-density lipoprotein cholesterol were significantly lower in anemia patients than in non-anemia patients (P < 0.05 or P < 0.01). The patients were followed up for 528 (178 - 675) days. After adjustment for potential co-variants in Cox regression analysis, pre-procedure anemia was associated with a significantly higher long-term mortality (RR: 3.293, 95%CI: 1.431 - 7.578, P < 0.01).</p><p><b>CONCLUSION</b>Pre-procedure anemia is an independent predictor of long-term mortality in elderly patients with acute coronary syndrome after percutaneous coronary interventions.</p>

Comparison of glycemic variability and glycated hemoglobin as risk factors of coronary artery disease in patients with undiagnosed diabetes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The role of chronic hyperglycaemia as a coronary artery disease (CAD) risk factor is well-known, and the glycemic variability is still a matter of debate. The aim of this study was to investigate the association of admission glycemic excursion and hemoglobin A(1c) (HbA(1c)) with the presence and severity of CAD in patients with undiagnosed diabetes mellitus (DM).</p><p><b>METHODS</b>We studied 286 newly diagnosed DM patients without prior revascularization undergoing coronary angiography for suspected ischaemic chest pain. Patients were grouped into those with CAD and without CAD according to angiographic results. The severity of CAD was assessed using the Gensini score. Glycemic variability, indicated as the mean amplitude of glycemic excursions (MAGE), was determined by a continuous glucose monitoring system. Serum levels of HbA(1c) and high-sensitive C-reactive protein (hs-CRP) as well as plasma concentrations of fasting glucose, lipids and creatinine were measured in all patients. Predictors of CAD were determined using multivariate Logistic regression model and receiver-operating characteristic (ROC) curves.</p><p><b>RESULTS</b>The newly diagnosed DM patients with CAD were older, and more were male and current cigarette smokers compared with the patients without CAD. The CAD group had significantly higher levels of MAGE and HbA(1c). Individuals with high levels of HbA(1c) (≥ 7%) or MAGE (≥ 3.4 mmol/L) had also significantly higher CAD prevalence. Logistic regression analysis revealed that high MAGE level and high HbA(1c) level were independent predictors for CAD. The area under the receiver-operating characteristic curve for MAGE (0.606, P = 0.005) was superior to that for HbA(1c) (0.582, P = 0.028). Gensini score closely correlated with age, MAGE, HbA(1c), hs-CRP, creatinine and total cholesterol. Multivariate analysis indicated that age (P < 0.001), MAGE (P < 0.001), HbA(1c) (P = 0.022) and hs-CRP (P = 0.005) were independent determinants for Gensini score.</p><p><b>CONCLUSIONS</b>Both admission glycemic excursion and chronic hyperglycaemia are associated with the severity of CAD in newly diagnosed DM patients. MAGE displays a significant value in predicting CAD in patients with undiagnosed diabetes even more than HbA(1c).</p>

New compound heterozygous mutation causes partial combined 17 alpha-hydroxylase/17,20-lyase deficiency / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the CYP17A1 gene mutations in a Chinese 46,XX patient with partial combined 17 alpha-hydroxylase/17,20-lyase deficiency.</p><p><b>METHODS</b>Clinical data were retrospectively analyzed. The genomic DNA of the patient and her parents was isolated from whole blood. Seven pairs of primers were used to amplify eight exons and exon-intron boundaries of the CYP17A1 gene. The amplified PCR products were purified by agarose gel and then directly sequenced. In order to confirm the DNA sequences of different alleles, some fragments were inserted into pMD 18-T vector and then subclone sequenced. Sequencing results were compared to the established human CYP17A1 sequence.</p><p><b>RESULTS</b>The patient was new compound heterozygous of 5994-5995 delAT/7541 C>T. The mutation 5994-5995 del AT, causing amino acid I259H, 274X, was proposed to result early truncated protein which was lack of the activity center site of P450C17, whereas missense mutation 7541 C>T causing A398V did not lie in the active site of the enzyme according to the computer model of human P450C17. The 46, XX case had irregular menstruation and slightly hypertension and hypokalemia. The ACTH stimulating test as well as the result of the sex hormones suggested that there was partial 17 alpha-hydroxylase/17, 20-lyase enzyme activities in the adrenal and sexual gland. We speculate that A398V might conserve partial of the enzyme's activities. The genotype was coincident with phenotype.</p><p><b>CONCLUSION</b>More study should be done to have better understanding of the function of the mutated P450C17 enzymes.</p>

Study on the genetic mutations of 17 alpha-hydroxylase/17,20-lyase deficiency in Chinese patients / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the CYP17A1 gene mutations in Chinese patients with 17 alpha-hydroxylase/17, 20-lyase deficiency.</p><p><b>METHODS</b>Clinical data were retrospectively analyzed. The CYP17A1 gene mutations were detected in 5 cases with 17 alpha-hydroxylase/17, 20-lyase deficiency and their relatives. The genomic DNA of the patients was isolated from whole blood. Seven pairs of primers were used to amplify eight exons and exon-intron boundaries of the CYP17A1 gene. The amplified PCR products were purified by agarose gel and then directly sequenced. In order to confirm the DNA sequences of different alleles, some fragments were inserted into pMD 18-T vector and then sequenced. Sequencing results were compared to the established human CYP17A1 sequence.</p><p><b>RESULTS</b>Briefly, we found 2 kinds of compound mutations, of which were: (1) 6436-6438(TAC-->AA), causing amino acid Y329K, 418X; (2) 6531-6532(GC-->A), causing amino acid L361F, 418X. Among the five cases, four were homozygous for 6436-6438(TAC-->AA), whereas one was compound heterozygous for 6436-6438(TAC-->AA)/6531-6532(GC-->A). The clinical characteristics of 5 cases were all completely combined defects of 17 alpha-hydroxylase/17, 20-lyase, and they all carried two alleles of CYP17A1 gene mutations that all shifted the reading frame and resulted in truncated protein which lack of the activity center site of P450C17, of which corresponding with their clinical feature.</p><p><b>CONCLUSION</b>Nine alleles have the mutation of 6436-6438(TAC-->AA), accounting for 90% of total alleles (9/10). That suggests this kind of mutation may have racial specificity. More study should be done to have better understanding of the function of the truncated P450C17 enzymes.</p>

Rosiglitazone inhibits atherosclerosis in apolipoprotein E-knockout mice / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the effect of rosiglitazone on atherosclerosis and potential mechanism in ApoE-knockout mice.</p><p><b>METHODS</b>Thirty-two 6-week-old ApoE-knockout mice were used as atherosclerosis model in two groups: rosiglitazone group (n = 18) and control group (n = 14). Each group contained equal numbers of male and female mice. All mice were fed with normal chow diet. In addition to normal diet, rosiglitazone group received rosiglitazone 17 mg/kg of body weight/day. Venous bloods were collected for plasma glucose and lipid analysis, and aorta were prepared for morphologic and immunohistochemical analysis after 14 weeks. Aortic root (1 cm) was cut and prepared for paraffin slice. The histomorphometric analysis of atherosclerotic lesion was performed by means of HE; positive percentage of macrophage cell and tumor necrosis factor-alpha were measured by means of immunohistochemistry in cross section. The ratio of lesion/aortic wall surface in the rest aorta was measured by means of Sudan IV staining in longitudinal section.</p><p><b>RESULTS</b>The amount of fatty streak in rosiglitazone group was significantly greater than that of control group; the gross number of lesions and the number of fibrous plaque and atheromatous plaque were similar in two groups. There were no differences in percentage of lesions in cross section in two groups. Rosiglitazone could significantly reduce the extend of atherosclerosis of longitudinal section, decrease the amount of macrophage cell and the level of tumor necrosis factor-alpha in lesions. The plasma glucose was normal and similar in two groups, and total cholesterol, LDL-cholesterol and triglyceride were significantly higher in rosiglitazone group.</p><p><b>CONCLUSION</b>Rosiglitazone suppresses the expression of tumor necrosis factor-alpha, reduces the number of macrophage cell in lesion, and inhibits the development of atherosclerosis.</p>