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Objective:To explore the risk stratification value of coronary CT angiography (CCTA) in patients with non-obstructive coronary artery disease based on cluster analysis and to identify the high-risk population of cardiovascular adverse events in patients.Methods:Prospective consecutive patients with suspected coronary artery disease who underwent CCTA examination and were confirmed as non-obstructive coronary heart disease were enrolled in the General Hospital of Chinese PLA from January 1, 2015 to December 31, 2017. The clinical characteristics and CCTA diagnosis information of patients were collected, and then follow-up was performed to obtain adverse cardiovascular events. Firstly, the cluster analysis based on CCTA information divided the patients into different groups. Then, the risk of adverse cardiovascular events was compared between different groups. Finally, segment involvement score (SIS) score, Leiden score, SIS score combined with clinical characteristics, Leiden score combined with clinical characteristics, and cluster information combined with clinical characteristics were used to stratify the population, and the concordance index-time curve and net reclassification improvement (NRI) index were described to compare the risk stratification ability of the five different models.Results:A total of 3 402 patients with non-obstructive coronary artery disease were included in the study, of whom 104 had adverse cardiovascular events during the follow-up period. Cluster analysis based on CCTA information classified patients into 3 different groups. There were statistically significant differences in clinical characteristics, CCTA information, and survival outcomes between groups ( P<0.05). The results of the concordance index-time curve showed that the risk stratification ability of CCTA cluster information combined with clinical characteristics was better than the current SIS score, Leiden score, SIS score combined with clinical characteristics, Leiden score combined with clinical characteristics. At the 1-year and 2-year time cutoffs, cluster information combined with clinical characteristics showed a positive increase in INR compared with the first four models (INR was 0.248 and 0.293, 0.316 and 0.293, 0.147 and 0.003, 0.192 and 0.007, respectively). Conclusion:CCTA based on cluster analysis has a good risk stratification value for patients with non-obstructive coronary artery disease and is helpful for individualized intervention.
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Objective@#To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI). @*Materials and Methods@#We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the oneweek CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC). @*Results@#Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00–1.07); P = 0.031) and RAD score (OR: 3.43 (2.34–5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75–0.89) in the training set and 0.75 (0.62–0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72–0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52–0.84) to 0.82 (0.70–0.93) (P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65–0.94) (P = 0.727). @*Conclusion@#Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters.
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This study introduced the current testing content and standards of ECG medical electronic instruments, combined with actual clinical needs, and discussed the comprehensive verification and evaluation protocol for ECG medical electronic instruments. The protocol mainly includes hardware performance testing, automatic diagnostic function testing and clinical application evaluation. The protocol emphasizes the clinical practicality and importance of the comprehensive verification and evaluation program, and provides a reference for the institutions involved in the program.
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Electrocardiography , Electronics, Medical , Reference StandardsABSTRACT
Objective:To develop a pretest probability model of obstructive coronary artery disease with machine learning based on multi-site Chinese population data.Methods:Chinese regiStry in early deTection and Risk strAtificaTion of coronary plaques (C-Strat) study is a prospective multi-center cohort study, in which consecutive patients with suspected obstructive coronary artery disease and ≥64 detector row coronary computed tomography angioplasty (CCTA) evaluation were included. Data from the patients were randomly split into a training set (70%) and a test set (30%). More than 50% of coronary artery stenosis by CCTA was defined as positive outcome. A boosted ensemble algorithm (XGBoost), 10-fold cross-validation and Bayesian optimization were used to establish a new prediction model-CARDIACS(pretest probability model from Chinese registry in eARly Detection and rIsk stratificAtion of Coronary plaques Study), and a logistic regression was used to establish a model-LOGISTIC in training set. The test set was used for validation and comparison among CARDIACS, LOGISTIC, UDFM (updated Diamond-Forrester Model) and DFCASS(Diamond-Forrester and CASS).Results:The study population included 29 455 patients with age of (57.0±9.7) years and 44.8% women, of whom 19.1% (5 622/29 455) had obstructive coronary artery disease. For CARDIACS, the age, the reason for visit and the body mass index (BMI) were the most important predictive variables. In the independent test set, the area under the curve (AUC) of CARDIACS was 0.72 (95% CI 0.70-0.73), which was significantly superior to that of LOGISTIC (AUC 0.69, 95% CI 0.68-0.71, P=0.015), UDFM (AUC 0.64, 95% CI 0.62-0.65, P<0.001) and DFCASS (AUC 0.66, 95% CI 0.64-0.67, P<0.001), respectively. Conclusion:Based on Chinese population, the study developed a new pretest probability model--CARDIACS, which was superior to the traditional models. CARDIACS is expected to assist in the clinical decision-making for patients with stable chest pain.
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This study established a rapid ECG screening system through the application of wearable ECG equipment. The closed-loop and self-service process of ECG inspection, data collection, transmission and printing have been realized. The new rapid ECG screening system docking with HIS system in the hospital, forming a new intelligent mode of rapid ECG screening. This paper introduces the design of the intelligent mode of ECG rapid screening from the aspects of hardware, software, wearable ECG examination equipment, and briefly describes its implementation path and technical scheme. With the rapid ECG screening system, human power can be saved, the timeliness of ECG examination can be enhanced. The level of ECG diagnosis in the basic units can be improved through building a multiple medical centers which is rely on the cloud platform.
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Humans , Electrocardiography , Equipment Design , Research , Software , Wearable Electronic DevicesABSTRACT
OBJECTIVES@#This study evaluated the prognostic power of serum uric acid (UA) in predicting adverse events in elderly acute coronary syndrome (ACS) patients with diabetes mellitus (DM).@*METHODS@#The analysis involved 718 ACS patients >80 years old whose general clinical data and baseline blood biochemical indicators were collected prospectively from January 2006 to December 2012. These patients were classified into two groups based on DM status, and then followed up after discharge. The Kaplan-Meier method was used for major adverse cardiac event (MACE) rates and all-cause mortality. Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis. Receiver operating characteristic (ROC) curves were analyzed to predict the cutoff value of UA in elderly ACS patients with DM. There were 242 and 476 patients in the DM and non-DM (NDM) groups, respectively, and the follow-up time after discharge was 40‒120 months (median, 63 months; interquartile range, 51‒74 months).@*RESULTS@#The all-cause mortality, cardiac mortality, and MACE rates in both DM and NDM patients were higher than those in the control group (@*CONCLUSIONS@#Serum UA level is a strong independent predictor of long-term all-cause death and MACE in elderly ACS patients with DM.
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It is significant to establish scene ECG database which improves the automatic diagnostic function of electrocardiograph under different application scenarios. We built the ECG database in different scene according to the hospital level (grade 3, grade 2, grade 1) and clinical environment (intensive care and acute wards, outpatient clinics and general wards). Sample size was obtained according to the incidence of various ECG diagnoses. The database covers ECG signal, ECG waveform, ECG characteristic values, ECG diagnostic results by experts and clinical information of patients etc. It not only provides important reference for electrocardiograph manufacturers to evaluate and test the parameters of automatic diagnosis under different clinical scene, but also provides valuable scientific research and teaching resources for medical workers.
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Humans , Databases, Factual , ElectrocardiographyABSTRACT
OBJECTIVE@#To train convolutional networks using multi-lead ECG data and classify new data accurately to provide reliable information for clinical diagnosis.@*METHODS@#The data were pre-processed with a bandpass filter, and signal framing was adopted to adjust the data of different lengths to the same size to facilitate network training and prediction. The dataset was expanded by increasing the sample size to improve the detection rate of abnormal samples. A depth-wise separable convolution structure was used for more specific feature extraction for different channels of twelve-lead ECG data. We trained the two classifiers for each label using the improved DenseNet to classify different labels.@*RESULTS@#The propose model showed an accuracy of 80.13% for distinguishing between normal and abnormal ECG with a sensitivity of 80.38%, a specificity of 79.91% and a F1 score of 79.35%.@*CONCLUSIONS@#The model proposed herein can rapidly and effectively classify the ECG data. The running time of a single dataset on GPU is 33.59 ms, which allows real-time prediction to meet the clinical requirements.
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Humans , Algorithms , Arrhythmias, Cardiac , Diagnosis , Databases as Topic , Electrocardiography , Classification , Methods , Neural Networks, Computer , Sensitivity and SpecificityABSTRACT
Objective To learn the endocardial strain patterns of the left ventricles on the short-axis views in normal youth volunteers using feature tracking techniques on cine cardiac MR imaging,and to build up the reference ranges of strain peak and time to peak (TTP) for endocardial strain analysis.Methods Twenty-nine normal youth volunteers aged from 24-34 years old were enrolled in the study in march 2015.The Cine MR imaging were acquired using balance FFE sequence with 24 phases for each cardiac cycle.The standard short-axis imaging planes were basal,mid-cavity and apical levels and divided into 16 segments.The peaks and TTPs of myocardial displacement and its velocity,radial and circumferential strain and strain rate and its velocity in each segment were calculated using feature tracking techniques.The data with normal distribution were analyzed by ANOVA and Student-Newman-Keuls (SNK) method,and Kruskal-Wallis and Wilcoxon rank sum test were used for the data without normal distribution.Results The peaks and TTPs of radial strain and strain rate differed in 16-segmental levels and basal,middle and apical plane levels and had no concordant reference ranges.The circumferential strain and strain rate were homogeneous at basal and middle plane levels [(-27.09 ±9.51)％,(1.94 ±0.98)/s,respectively].Their TTPs were homogenous [0.38 (0.08)RR,0.54 (0.08)RR,respectively],and there were no significant differences in planar-segments or inter-segment level.Except for middle level,the peaks of radial displacement and velocity differed in basal and apical levels and had no concordant reference ranges.But radial velocity TTPs were homogeneous in all 16 segments [0.21 (0.04)RR].Except for the radial strain rate,TTPs showed no significant difference between basal level and middle level.The measurements at apical level revealed high variance.No regular pattern could be found on individual peak and TTP curves of velocity and strain rate.Conclusion The peaks and TTPs of radial strain are different in segmental and planar levels without a concordant reference range.The peaks and TFPs of circumferential strain and the radial velocity rTTPs are homogeneous in middle and apical plane level and have homogeneous reference range.
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Objective To evaluate the diagnostic performance of the automated quantitative analysis by coronary computed tomography angiography (CCTA) for lesion specific hemodynamic significance assessed by fractional flow reserve(FFR). Methods One hundred and fifteen patients with one hundred and fifty?one vessels,who successively underwent invasive coronary angiography with evaluation of FFR(values≤0.8 were defined as lesion specific hemodynamically significant), were analyzed by coronary CT angiography. FFR≤0.80 was found in 54(35.76％) of the 151 vessels, which was divided into two groups (group of hemodynamically significant and group of hemodynamically non-significant). CCTA images were quantitatively analyzed with automated software to obtain the following index:minimal lumen diameter(MLD), maximum diameter stenosis(MDS％), minimal lumen area(MLA), maximum area stenosis(MAS％), lesion length (LL), total plaque volume(TPV), total plaque burden(TPB), calcified plaque volume(CPV), calcified plaque burden (CPB), non-calcified plaque volume(NCPV), non-calcified plaque burden(NCPB), lipid plaque volume(LPV), lipid plaque burden(LPB), fibrous plaque volume(FPV), fibrous plaque burden(FPB), napkin-ring sign(NRS), remodeling index(RI) and eccentric index(EI). Logistic regression and area under the receiver operating characteristics were used for statistical analysis. Results MDS％(65.04％± 8.20％), MAS％(73.91％± 7.58％), TPB(57.96％± 11.17％), CPB[4.32％(0.11％, 5.34％)], LPB[14.89％(9.30％, 19.23％)], CPV[30.68 (0.29, 33.36)mm3], LPV[(81.72(33.92, 94.68)mm3]in the group with hemodynamic significance were larger than those in group with normal hemodynamic status[58.27％± 9.50％, 64.83％± 8.31％, 53.88％± 11.77％, 2.05％(0.00％, 3.42％), 11.83％(6.34％, 16.8％), 12.53(0.00, 13.24)mm3, 60.71(24.1, 75.11)mm3, respectively], which was statistically significant(t=4.41,P<0.01;Z=6.63,P<0.01;t=2.08,P<0.05;Z=-2.47,P<0.01;Z=-2.30,P<0.05;Z=-2.48, P<0.01;Z=-2.55, P<0.01, respectively). MLD[1.24(1.04, 1.46)mm]and MLA[3.61(2.40, 4.80) mm2]in the group with hemodynamic significance were smaller than those in group with normal hemodynamic status[1.53(1.32,1.72)mm, 5.28(4.00,6.40)mm2],which was statistically significant[Z=-4.82,-5.40, respectively;P<0.01].In logistic regression analysis, only MAS％(OR:1.08,95％CI:1.01-1.15,P=0.02), CPB (OR:1.16,95％CI:1.02-1.33,P=0.02) and LPB(OR:1.10,95％CI:1.01-1.19,P=0.02), MLA(OR:0.69, 95％CI:0.49-0.98,P=0.04)were significant predictors of hemodynamic significance. For predicting lesion specific hemodynamic significance, compared with MLA(0.76), MDS％(0.71), CPB(0.62) and LPB(0.61), except for MLA(Z=0.77, P=0.44), the AUC of MAS％(0.79) was significantly increased(Z=2.54, P=0.01;Z=2.91, P<0.01;Z=2.94, P<0.01, respectively). However, combination of other index to MAS％[MAS％+MLA％(0.81), MAS％+MDS％(0.80), MAS％+TPB(0.80), MAS％+CPB(0.80), MAS％+LPB(0.81)] did not show significantly difference over MAS％(Z=1.10, 0.71, 0.40, 0.54, 1.07, respectively;P>0.05). Conclusion Compared with diameter stenosis, area stenosis substantially improves the prediction of lesion specific hemodynamic significance.
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Purpose To measure the longitudinal and transverse strain and displacement parameters of each segment of long axis myocardium on cardiac MRI film images of normal young volunteers using feature tracking technique (FT), and to analyze the regularity of left ventricular long axis strain and establish peak and time to peak (TTP) reference range concerning the longitudinal and transverse strain and displacement. Materials and Methods Cardiac film images of 29 healthy volunteers aged 24 to 34 were collected using Philips Multiva 1.5T MRI scanner, including three typical long axis planes of the left ventricular long axis, left ventricular outflow tract, and four-chamber view. The MRI film images were analyzed drawing on myocardial feature tracking software TOMTEC, and the peak value and TTP of longitudinal and transverse strain and displacement of the 16 AHA segments excluding apex cordis were obtained thereby. The regularity of each parameter concerning the plane, layer, and segment was summarized and analyzed. Results The TTP of longitudinal strain, longitudinal displacement and transverse strain were consistent among each myocardial segment, which was a constant indicator in (41.24±12.51) ％ RR interphase. The peak value of longitudinal displacement was represented by apex cordis (2.56±0.89) mm < middle (6.09±2.03) mm < cardiac base (8.07±2.05) mm, and the peak value of transverse displacement was manifested as apex cordis (4.57±1.18) mm < middle (5.65±0.84) mm < cardiac base (8.48 ±1.18) mm, which was consistent with cardiac geometric deformation visually observed. The longitudinal strain showed consistency on 2CH-3CH-4CH plane, whose peak reference value was (-22.46±13.19)％; while the peak value of transverse strain displayed no consistency on different planes. Conclusion The longitudinal strain of the left ventricular on different planes has consistent peak value and TTP, suggesting good reference value.
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Objective: To evaluate the effects of blood lipid stability on progression of carotid atherosclerosis
Methods: A total of 416 patients who had physical examination in our hospital annually from January 2010 to December 2015 were selected and divided into a progression group [n=216] and a non-progression group [n=200] according to the intima-media thickness measured by carotid ultrasound. The levels of lipidrelated parameters within five years were retrospectively analyzed to calculate the smoothness index [SI = x/s]
Results: The cross-sectional TG, HDL-C, ApoAI, ApoB, ApoE and Lpa levels were similar in the two groups [p>0.05]. The non-progression group had significantly higher TC [[4.15 +/- 0.82 vs. 4.50 +/- 1.04] mmol/L] and LDL-C [[2.53 +/- 0.76 vs. 2.99 +/- 1.03] mmol/L] levels than those of the progression group [p<0.05].The progression group had significantly lower TC SI [5.29 +/- 1.28 vs. 5.65 +/- 1.76], TG SI [2.13 +/- 0.71 vs. 2.79 +/- 0.82], LDL-C SI [3.66 +/- 1.17 vs. 4.36 +/- 1.58], ApoB SI [3.37 +/- 0.88 vs. 3.62 +/- 0.95] and Lpa SI [1.53 +/- 0.49 vs. 1.62 +/- 0.43] than those of the non-progression group [p<0.05]
Conclusion: Compared with cross-sectional results, SI was better correlated with the progression of atherosclerosis. The progression group had lower SI values
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Objective@#To characterize the hemodynamic force towards coronary plaque based on noninvasive coronary computed tomographic angiography and to investigate its relationship with plaque features and stenosis severity by computational fluid dynamics.@*Methods@#Twenty-six patients underwent invasive fractional flow reserve measurement following coronary computed tomography angiography examination from March to September 2016 were retrospectively included. Computational fluid dynamics was applied and wall shear stress (WSS) and axial plaque stress (APS), which extracted the axial component of hemodynamic stress acting on stenotic lesions, were calculated based on the results of noninvasive coronary computed tomographic angiography. Plaque analysis was performed to elucidate plaque features and relative plaque burden. The fluid dynamics distributions in lesions with different stenosis severity were investigated.@*Results@#Thirty-one coronary plaques with satisfactory imaging quality were analyzed, there were 11 (35.5%) dominant low WSS (<1 Pa) lesion and 20 high WSS lesion (64.5%), 8(25.8%) net retrograde APS lesion and 23(74.2%) anterograde lesion. Plaque volume was (78.5±48.6) mm3 and plaque burden was (69.1±12.1)% in the low WSS group, which was(60.5±57.3) mm3, and(57.5±14.0)%, respectively in the high WSS group, the plaque burden was significantly higher in the low WSS group than in the high WSS group (P=0.028), while the percentage of calcified plaque, fibrotic plaque and lipid core volume were similar between the two groups (P>0.05). Plaque volume was (79.7±69.1) mm3 and plaque burden was(68.7±13.7)% in the group with anterograde-dominant APS plaque, which was(61.7±24.9)mm3, and(68.9±10.4)%, respectively in the net retrograde APS lesion group (P>0.05). Percentage of lipid core area was significantly higher in the anterograde lesion group than in the retrograde lesion group ((25.1±18.1)% vs.(10.8±12.7)%, P=0.049). Both WSS and APS were significant higher in the severe obstructive coronary stenosis group than in non-severe obstructive coronary stenosis group (P<0.05). Although there was no difference in WSS between functional coronary ischemia group and non-functional coronary ischemia group ( (13.3±8.7) Pa vs. (12.5±14.2) Pa, P>0.05), the distribution of APS was different between the functional coronary ischemia group and non-functional coronary ischemia group ((1 698.8±652.6) Pa vs. (981.4±787.5) Pa, P<0.05).@*Conclusion@#WSS and APS can uniquely characterize the stenotic segment and has a strong relationship with lesion geometry. APS may be related to the necrotic core plaque and functional coronary ischemia. Clinical application of these hemodynamic and geometric indices may be helpful to assess the future risk of plaque progress and plaque rupture, which will be helpful on determining respective treatment strategy for patients with coronary artery disease.
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Objective To observe the effect of stress on the rapid component of delayed rectifier potassium current (IKr) in rat cardiomyocytes. Methods Forty male SD rats were randomly divided into four groups (10 each): control group (Ctrl), exhaustive group (ES), noise group (WN) and composite group (ES+WN). Stress animal models were prepared as follows: Rats in ES group were undergoing exhaustive swimming as the stress factor, in WN group undergoing white noise and in ES+WN group undergoing exhaustive swimming + white noise as the stress factor. Langendorff device was used to reversely perfuse collagenase for isolating the rat's ventricular myocytes. The effect of stress on IKr current and gating mechanism of single ventricular myocyte was recorded by whole-cell patch clamp technique. Results Compared with the Ctrl group, the tail current density of IKr (IKr,tail) of ventricular myocytes increased significantly in ES group and WN group (P<0.01). The IKr,tail current density of the ventricular myocytes in ES+WN group was significantly higher than that in ES group and WN group (P<0.01), and the effect was voltage dependent. Gating mechanism revealed that the half inactivation voltage of IKr,tail (V1/2,inact) can be shifted to the right in ES group, WN group and ES+WN group when compared with the Ctrl group, and the recovery time constant shortened after inactivation (P<0.01). However, the steady-state activation, fast inactivation constant and voltage dependence of IKr,tail were not statistically significant in ES group, WN group and ES+WN group when compared with the Ctrl group. Conclusion Stress increases the IKr current in rat cardiomyocytes, suggesting it be one of the electrophysiological bases of stress-induced arrhythmia.
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OBJECTIVE: This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL). MATERIALS AND METHODS: In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic. RESULTS: Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391–24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103–22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242–43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000–1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006). CONCLUSION: Noninvasive assessment of NCLs by CCTA has potential prognostic value.
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Humans , Adipose Tissue , Angiography , Cholesterol , Constriction, Pathologic , Coronary Vessels , Follow-Up Studies , Lipoproteins , Logistic Models , Myocardial Infarction , Percutaneous Coronary InterventionABSTRACT
Objective To investigate the evaluation of plasma osteoprotegerin (OPG) measurement for assessing the prognosis of intermediate coronary lesions in elderly patients.Methods We retrospectively analyzed patients met the inclusion criteria of suspicious chest pain or confirmed coronary artery disease (CHD),and intermediate stenosis lesions (20 ％ ～ 70 ％) in 3 main coronary arteries served as target vessels for qualitative comparative analysis (QCA).Plasma OPG level was detected by protein array method,and the concentration of hypersensitive C-reactive protein (hs-CRP)was determined by enzyme-linked immunosorbent assay(ELISA).Clinical endpoints were followed up.Results A total of 890 patients with intermediate coronary stenosis were enrolled in this study,and were divided into＜60 years of age group(n＝370)and ≥ 60 years of age group(n＝520).There were statistical differences in age,smoking history,hypertension history,triglycerides (TG),high-density lipoprotein cholesterol(HDL-C),white blood cell count,OPG,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI)between the two groups.The morphological indices in coronary lesions assessed by QCA had no differences between the two groups.During a median of 24 months of follow-up,58 patients(l1.2％)had clinical endpoints events.Age,smoking history,hypertension history,TC,TG,HDL-C,white blood cell count,levels of OPG above-median,hs-CRP,SBP,DBP,and BMI were used as the independent variables,and the clinical end events as the dependent variable.Forward stepwise logistic regression analysis showed that HDL-C,levels of OPG above-median,hs-CRP were the independent risk factors in elderly patients.The risk of cardiovascular events in patients with levels of OPG above-median was 2.510 fold higher than those with levels of OPG below-median.Conclusions The high levels of OPG and hs-CRP are the independent risk factors for the occurrence of coronary heart disease in the elderly with intermediate coronary lesions.
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<p><b>OBJECTIVE</b>To investigate the effect of liraglutide, an analogue of glucagon-like peptide-1, on the proliferation and migration of cardiac microvascular endothelial cells (CMECs) and explore the mechanism.</p><p><b>METHODS</b>In vitro cultured CMECs of SD rats were purified by differential adhesion method and identified immunocytochemically using CD31 antibody and factor VIII. MTT assay was performed to assess the proliferation of the first-generation cells exposed to different concentrations (0-1000 nm/L) of liraglutide. Western blotting was used to detect the activation of PI3K/Akt and MAPK/ERK signaling pathways. BrdU fluorescent labeling and scratch assay were performed to observe the proliferation and migration of CMECs following liraglutide treatment, and PI3K/Akt and MAPK/ERK pathway inhibitors LY294002 and PD98059, respectively, were used to further confirm the role of these signaling pathways in regulating the proliferation and migration of CMECs.</p><p><b>RESULTS</b>Immunocytochemical staining demonstrated a proportion of double positive cells exceeding 95%. The cells exhibited a logarithmic growth 48 h after plating. Liraglutide exposure concentration-dependently promoted the proliferation of CMECs with the optimal concentration of 100 nmol/L (P<0.05). Liraglutide exposure of the cells for 24 h significantly increased the levels of intracellular phosphorylated Akt and ERK (P<0.05), but pretreatment of the cells with Akt and ERK signaling pathway inhibitors 1 h before liraglutide obviously reversed such effect (P<0.05). BrdU and scratch assay showed that 100 nmol/L liraglutide significantly promoted the proliferation and migration of CMECs (P<0.05), but such effects were obviously suppressed by Akt and ERK inhibitors (P<0.05).</p><p><b>CONCLUSION</b>Liraglutide promotes the proliferation and migration of CMECs in vitro via PI3K/Akt and MAPK/ERK signaling pathways.</p>
Subject(s)
Animals , Rats , Cell Movement , Cell Proliferation , Cells, Cultured , Chromones , Endothelial Cells , Cell Biology , Flavonoids , Glucagon-Like Peptide 1 , Pharmacology , Liraglutide , MAP Kinase Signaling System , Morpholines , Myocardium , Cell Biology , Phosphatidylinositol 3-Kinases , Metabolism , Phosphorylation , Rats, Sprague-DawleyABSTRACT
Purpose To explore the image quality, radiation dose and diagnostic accuracy of double flash scanning mode in patients with coronary artery stent. Materials and Methods Sixty-three patients with coronary stents underwent CT coronary artery imaging using conventional coronary artery angiography as the gold standard. Double flash mode was used in patients with heart rate ≤ 70 beats per minute. Spiral scanning was used in patients with heart rate between 70-100 beats per minute. The image quality, vascular CT value, noise, SNR and CNR were compared. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were determined, and the radiation dose was calculated. Results There were 59 stents in Double flash group (57 were diagnostic) and 58 stents in spiral group (all diagnostic). There was no statistically significant difference in image quality, CT value, noise, SNR or CNR for the first scan between two groups (P>0.05). Image quality for the second scan in Double flash group showed statistical difference with the first scan and spiral group (P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Double flash and spiral group were 90.0%, 89.8%, 64.3%, 97.8%, 89.8% and 83.3%, 95.7%, 83.3%, 95.7% 93.1%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for stents with diameter ≥ 3.0 mm were significantly higher than stents with diameter <3.0 mm. The radiation doses of Double flash group were significantly lower than the spiral group (P<0.05). Conclusion Double Flash mode scanning provides good image quality and diagnostic accuracy with lower radiation dose in patients with coronary artery stents. Imaging of stents with diameter ≥ 3.0 mm is superior to stents with diameter <3.0 mm.
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Objective To investigate the correlation between the levels of placenta growth factor (PLGF),soluble angiopoietin receptor-2 (sTie-2) and critical coronary artery plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease (CHD).Methods In three consecutive years from April 2007 to September 2009,a cohort of 719 patients with borderline coronary lesions with stenosis in three main vessels with lumen diameter reduction varied all the way from more than 20％ to less than 70％ and with greater than 2.25 mm of the inner diameter were selected in this study from 4 teaching hospitals of tertiary class A in Beijing.These patients fell into three categories:unstable angina pectoris (UAP,n =292),stable angina pectoris (SAP,n =219) and coronary arteriosclerosis (AS,n =208).The vessels involved were analyzed using quantitative coronary angiography (QCA).Plasma levels of PLGF and sTie-2 were measured by using protein chip.The relationship between plasma levels of vascular factors,sTie-2,PLGF and coronary artery plaque imaging morphology among three groups were analyzed.Results (1) Plasma level of PLGF was 80.33 ng/L in the UAP group,which was significantly higher than 54.29 ng/L in the SAP group and 45.16 ng/L in AS group (both P ＜0.05).Plasma level of sTie-2 was 1353.06 ng/L in the UAP group,which was significantly higher than 1308.28 ng/L in the AS group (P =0.008).(2) There was significantly statistical differences in QCA between the SAP group and the UAP group as well as the AS group (both P ＜ 0.05) in terms of the minimal lumen diameter,diameter stenosis rate,minimal lumen cross-sectional area and cross-sectional area of stenosis.The plaque area in the UAP group was larger than that in the AS group (P =0.013).(3) The relationship between vascular factors and plaque imaging morphology was analyzed.There was significantly statistical difference in the involved lesions among the three groups (P ＜ 0.01).(4) There was a positive correlation between plasma level of PLGF and minimal lumen cross-sectional area (r =0.493,P =0.009).Conclusions The plasma levels of PLGF and sTie-2 reflect the level of neo-vascularization in the plaque,and could be taken as predictive factors for potential pathogenesis of coronary plaque.
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<p><b>OBJECTIVE</b>To investigate the mechanism by which exendin-4 promotes paracrine secretion of cytokines by adipose-derived stem cells (ADSCs).</p><p><b>METHODS</b>In vitro cultured SD rat ADSCs (fourth passage) with or without exendin-4 treatment underwent flow cytometry to characterize the surface markers. MTT assay was performed to assess the proliferation of the cells exposed to different concentrations (0-20 nm/L) of exendin-4, and the paracrine secretion of cytokines (bFGF, VEGF, HGF, and IGF-1) by the ADSCs was evaluated by qPCR. The changes in the expressions of p-Akt in the cells were analyzed by Western blotting and qPCR in response to exendin-4 (10 nm/L) with or without exposure to PI3K/Akt inhibitor LY-294002 (50 nm/L); bFGF, VEGF, HGF, and IGF-1 production in the cells were detected using ELISA kits.</p><p><b>RESULTS</b>Treatment with exendin-4 for 12 h did not affect the surface marker profile of the ADSCs but promoted the cell proliferation (P<0.05). Exendin-4 significantly increased the mRNA expressions of VEGF, bFGF, HGF, and IGF-1 in a concentration-dependent manner, and 10 nm/L was the optimum concentration (P<0.05). Exendin-4 treatment resulted in significantly increased p-Akt expressions in the ADSCs, and PI3K/Akt inhibitor not only reversed such effects of exendin-4 on p-Akt but also diminished the exendin-4- mediated up-regulation of the paracrine cytokines.</p><p><b>CONCLUSION</b>Exendin-4 can concentration-dependently promote the proliferative and paracrine capacities of ADSCs partially through the PI3K/Akt signaling pathway without affecting the surface marker profile of the cells.</p>