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RESUMEN Introducción: En el diagnóstico y seguimiento de la hipertensión arterial (HTA) la mayoría de las guías de práctica recomiendan el monitoreo ambulatorio de la presión arterial (MAPA). En este sentido, existe cada vez más evidencia que respalda la superioridad de la hipertensión arterial nocturna (HTAN) como predictor de eventos cardiovasculares. Se sabe poco sobre la relación con los eventos cardiovasculares según la gravedad de la HTAN. Además, no está claro a partir de qué valor de presión arterial nocturna comienza a aumentar el riesgo. Objetivos: Conocer si la presencia de HTAN y sus niveles de gravedad se asocian con resultados cardiovasculares adversos durante el seguimiento. Material y métodos: Estudio observacional. Realizamos un análisis de los datos obtenidos en un centro médico de alta complejidad de Buenos Aires, recopilados a partir de estudios de MAPA de 24 horas. Examinamos las características clínicas de los pacientes, los resultados de laboratorio, los estudios de imagen y sus resultados durante el período de seguimiento. Nuestro estudio incluyó personas de 18 años o más a las que se les había diagnosticado hipertensión. Definimos HTAN como aquellos casos con valores de presión arterial ≥ 120/70 mmHg durante el periodo nocturno. Resultados: Fueron incluidos 981 pacientes en el análisis final. De ellos, el 53 % eran hombres; la edad media era de 59,4 años. Presentaban HTAN 63,6 % (n=624). Clasificamos la HTAN en cuatro estratos de gravedad para comparar, según el valor de presión arterial sistólica nocturna: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg y 160-220 mmHg. Se registraron eventos adversos cardiovasculares mayores en 8 (2,2 %), 17 (4,1 %), 8 (5,6 %) y 7 (11,3 %) sujetos, respectivamente, y esta diferencia entre grupos fue estadísticamente significativa (p=0,007). El análisis multivariado de regresión de Cox demostró que la presencia de HTAN fue un predictor independiente de eventos cardiovasculares adversos (HR 3,60; IC 95% 1,12-11,5; p=0,033), incluso al considerar la presencia de hipertensión arterial diurna. Conclusión: En esta cohorte contemporánea, la HTAN y su gravedad se asociaron independientemente con la incidencia de eventos cardiovasculares adversos.
ABSTRACT Background: In the diagnosis and follow-up of arterial hypertension (HTN) most practice guidelines recommend ambulatory blood pressure monitoring (ABPM). In this regard, there is increasing evidence supporting the superiority of nocturnal hy pertension (NHTN) as a predictor of cardiovascular events. Little is known about the relationship with cardiovascular events according to the severity of NHTN. Furthermore, it is unclear from what nighttime pressure value the risk begins to increase. Objectives: The aim of this study was to determine whether the presence of NHTN and its severity levels are associated with adverse cardiovascular outcomes during follow-up. Methods: An observational study was performed analyzing data collected from 24-hour ABPM studies obtained in a high complexity medical center in Buenos Aires. We examined patients' clinical characteristics, laboratory findings, imaging studies and their results during the follow-up period. Our study included ≥18 year-old persons who had been diagnosed with hypertension. We defined NHTN as those cases with blood pressure values ≥120/70 mmHg during the nighttime period. Results: The final analysis included 981 patients. Among these, 53% were men, mean age was 59.4 years and NHTN was present in 63.6% of cases (n=624). Nocturnal HTN was classified into four severity strata for comparison, according to the nighttime systolic blood pressure value: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg and 160-220 mmHg. Major adverse cardiovascular events were recorded in 8 (2.2%), 17 (4.1 %), 8 (5.6%) and 7 (11.3%) subjects, respectively, and this differ ence between groups was statistically significant (p=0.007). Multivariate Cox regression analysis showed that the presence of NHTN was an independent predictor of adverse cardiovascular events (HR 3.60; 95% CI 1.12-11.5; p=0.033), even when considering the presence of daytime hypertension. Conclusion: In this contemporary cohort, NHTN and its severity were independently associated with the incidence of adverse cardiovascular events.
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Coronary heart disease(CHD)is a common cardiovascular disease in clinic,which can be classified as"chest qi-obstruction"and"heart pain"in traditional Chinese medicine.Professor LI Yan believes that CHD can be differentiated as the syndrome of deficiency in origin and excess in superficiality,and the deficiency in origin is characterized by the deficiency of spleen and the failure of spleen and stomach in transportation,while the excess in superficiality manifests as the obstruction of visible pathogens such as phlegm turbidity,blood stasis,qi stagnation,and cold accumulation.The clinical treatment should focus on regulating the spleen and stomach,using Astragali Radix,Atractylodis Macrocephalae Rhizoma,Codonopsis Radix,Schisandrae Chinensis Fructus to strengthen the spleen and nourish the heart in order to treat the root cause.Moreover,therapies of activating yang to remove turbidity,activating blood to remove stasis,soothing liver to rectify qi,and warming yang to dissipate the cold can be adopted.Therefore,the symptom and root cause will be treated simultaneously,the unblocking and supplementing effect will be achieved,and then the spleen-qi is vigorous,the heart qi is in abundance,the blood stasis and the phlegm are removed,and the chest yang can be stretched.As a result,the heart vessels are unblocked,and the symptoms of chest qi-obstruction will be relieved.Professor LI Yan's experience from the perspective of spleen and stomach can provide reference for the clinical diagnosis and treatment of CHD with traditional Chinese medicine.
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Objective To investigate the correlation of triacylglycerol glucose(TyG)index,monocyte to high-density lipoprotein cholesterol ratio(MHR)with coronary artery disease and myocardial ischemia degree in coronary heart disease(CHD),and to analyze the two Predictive value of coronary artery disease and myocardial ischemia degree.Methods CHD patients from the 920th Hospital of the Chinese People's Liberation Army Joint Logistics Support Force from January 2019 to January 2022 were selected as the study group(n = 150),and healthy physical examination subjects from the same period were selected as the control group(n = 75).The TyG index and MHR of the two groups were compared and analyzed.The extent of coronary artery disease was evaluated based on the Gensini score,and the TyG index and MHR of patients with different coronary lesions and myocardial ischemia were compared,and their correlation with Gensini score and myocardial ischemia was analyzed.The predictive value of TyG index,MHR,and the combined detection of both for coronary lesions and myocardial ischemia was evaluated using receiver operating characteristic(ROC)curves and area under the curve(AUC).Results The TyG index and MHR of the study group were(4.12±0.35)and(0.26±0.08)×109,respectively,which were higher than those of the control group(4.94±0.55)and(0.43±0.12)×109,and the TyG index and MHR of severe coronary artery disease>moderate coronary artery disease>mild coronary artery disease,acute myocardial infarction TyG index,MHR>unstable angina pectoris>stable angina pectoris(P<0.05);TyG index and MHR were positively correlated with Gensini score(r = 0.621,0.635,P<0.05),and positively correlated with the severity of myocardial ischemia(r = 0.617,0.642,P<0.05).The AUC of TyG index and MHR for the joint identification of mild coronary artery disease and moderate coronary artery disease was 0.917,which was greater than the AUCs of 0.749 and 0.832 for the two conditions individually.The AUC of TyG index and MHR for the joint identification of mild to moderate coronary artery disease and severe coronary artery disease was 0.935,which was greater than the AUCs of 0.770 and 0.767 for the two conditions individually(P<0.05).The AUC of TyG index and MHR for the joint identification of stable angina pectoris and unstable angina pectoris was 0.922,which was greater than the AUCs of 0.812 and 0.824 for the two conditions individually.The AUC of TyG index and MHR for the joint identification of stable angina pectoris,unstable angina pectoris,and acute myocardial infarction was 0.913,which was greater than the AUCs of 0.708 and 0.714 for the two conditions individually(P<0.05).Conclusions TyG index and MHR are positively correlated with Gensini score and myocardial ischemia degree.The combined detection of the two has a higher application value in the evaluation of coronary artery disease and myocardial ischemia degree.
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Objective·To explore the correlation between body compositions and cardiovascular fitness(CRF)in patients with coronary heart disease(CHD).Methods·The CHD patients(CHD group)who underwent elective percutaneous coronary intervention treatment at Renji Hospital,Shanghai Jiao Tong University School of Medicine from October 2022 to June 2023 as well as healthy people(control group)were selected.All the participants completed cardiopulmonary exercise testing(CPET)to determine CRF and bioelectrical impedance analysis(BIA)to determine body compositions on the same day.Results·A total of 191 patients with coronary heart disease and 188 healthy individuals were included.There was no statistically significant difference in baseline characteristics between the two groups.Compared with the control group,the CRF indicators of the CHD group were significantly reduced(all P<0.05).In terms of body composition indicators,the trunk muscle mass(TMM)of the CHD group was significantly lower than that of the control group(P<0.01),and the trunk fat mass(TFM)was significantly higher than that of the control group(P<0.01).Correlation analysis showed that TMM(R=0.538),lower limbs muscle mass(LMM)(R=0.754),and lower limbs fat mass(LFM)(R=0.593)were positively correlated with peak oxygen uptake per kilogram of bodyweight(VO2peak/kg)in the CHD group(all P<0.01),while TFM(R=-0.563)was negatively correlated with VO2peak/kg(P<0.01).There was no statistically significant correlation between other body composition indicators and VO2peak/kg.According to VO2peak/kg,the CHD patients were divided into low CRF group,medium CRF group,and high CRF group.The results showed that there were statistically significant differences in LMM,TMM,LFM,and TFM among the three groups of patients(all P<0.05).Multiple linear regression analysis suggested that age,gender,TMM,TFM,LMM,and LFM were related factors of VO2peak/kg in the patients with CHD.The VO2peak/kg of CHD patients increased with the increase of TMM,LMM,and LFM and the decrease of age and TFM;the female patients had lower VO2peak/kg compared to the males.Conclusion·The CRF of CHD patients is significantly lower than that of the healthy population,with higher TFM and lower TMM;in the CHD patients,CRF is negatively correlated with TFM and positively correlated with TMM,LMM,and LFM.
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Objective:To explore the evaluation of 256 slice spiral computed tomography angiography(CTA)of coronary,serum lipoprotein associated phospholipase A2(Lp-PLA2)and angiopoietin like protein 3(ANGPTL3)on the severity of coronary artery stenosis of patients with coronary heart disease.Methods:A total of 102 patients with coronary heart disease who were diagnosed and treated at Hebei Chest Hospital from July 2022 to March 2023 were selected as the study subjects.According to the Gensini score about the severity of coronary artery stenosis,they were divided into mild stenosis group(0 score≤Gensini score≤20 scores),moderate stenosis group(20 scores<Gensini score≤60 scores)and severe stenosis group(Gensini score>60 scores),with 34 cases in each group.The minimum lumen diameter(MLD),percentage of area of stenosis(%AS),percentage of diameter of stenosis(%DS),minimum lumen area(MLA),Lp-PLA2 and ANGPTL3 among three groups were compared.The diagnostic efficiency of the severity of coronary artery stenosis was predicted according to receiver operating characteristic(ROC)curve.Results:The MLA and MLD values in severe stenosis group were significantly lower than those in moderate and mild stenosis groups,while%AS and%DS were significantly higher than those in moderate and mild stenosis groups(t=6.905,4.083,5.871,6.976,3.387,2.198,2.668,3.505,P<0.05),respectively.The Lp-PLA2 and ANGPTL3 values in severe stenosis group were significantly higher than those in moderate and mild stenosis groups(t=4.164,8.220,2.575,3.050,P<0.05),respectively.ROC curve analysis showed that the area under curve(AUC)values of MLA,MLD,%AS,%DS,CCTA comprehensive parameter,LpPLA2 and ANGPTL3 were respectively were 0.838,0.690,0.742,0.801,0.904,0.808 and 0.807 in predicting the severity of coronary artery stenosis.The sensitivities of them were respectively 91.20%,91.20%,64.70%,94.10%,97.10%,70.60%and 88.20%.The specificities of them were respectively 76.50%,57.40%,75.00%,50.00%,70.60%,97.10%and 70.60%.The AUC value of CCTA comprehensive parameter was respectively higher than that of LpPLA2 and ANGPTL3,but the difference was not statistically significant(P>0.05).Conclusion:256 slice spiral CCTA,serum Lp-PLA2 and ANGPTL3 have a certain efficiency in assessing the severity of coronary artery stenosis of coronary heart disease,and 256 slice spiral CCTA has higher predictive efficiency.
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Objective To build a knowledge graph;To visualize the knowledge structure relationships and clinical thinking in the treatment of coronary heart disease by renowned TCM doctors;To provide methodological reference for the inheritance of experience of renowned TCM doctors.Methods Medical records about treatment of coronary heart disease by renowned TCM doctors were retrieved from CNKI from the establishment of the database to 30th,Nov.2022.The characteristics of TCM diagnosis and treatment and the characteristics of the theoretical system of syndrome differentiation and treatment in TCM were analyzed.Concept types and relationships between concepts were sorted out and extracted to form a pattern layer of knowledge graph;based on the characteristics of the pattern layer,Python 3.11(PyCharm 2022.3.2)was used to write rules,and knowledge extraction and data import were implemented through the Pandas library,Openpyxl library and Py2neo library,which were stored in the graph database Neo4j-Community-5.2.0 to complete the construction of the knowledge graph.Implementing query application was realized through Cypher language.Results The data of 643 medical cases of 144 renowned TCM doctors were included,which were entered into the Neo4j graph database,forming a knowledge graph consisting of 2 744 nodes and 23 795 relationships under 8 concepts and 10 relationships,to achieve visual presentation and query application of the diagnosis and treatment process of coronary heart disease by renowned TCM doctors.Conclusion The knowledge graph can intuitively display the relationship of diseases-symptoms-syndromes-treatments-prescriptions-medicine in medical records,develop a knowledge system that is easy to retrieve,and improve the accessibility of domain knowledge,which can provide methodological reference for the inheritance of experience of renowned TCM doctors.
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Objective To investigate the biological basis of disease and syndrome by studying the spectrum of myocardial tissue metabolites in the rat model of coronary heart disease with heart blood stasis syndrome.Methods SD rats were randomly divided into sham-operation group and model group.The left anterior descending coronary artery was ligated to prepare the rat model of coronary heart disease with heart blood stasis syndrome.The general condition was observed,and the tongue chromaticity,electrocardiogram,cardiac function were detected.HE staining and transmission electron microscopy were used to observe myocardial tissue morphology and ultrastructure.UPLC-MS technology was used to investigate the differential metabolites in rat myocardial tissue,and enrichment analysis was conducted on metabolic pathways.Results Compared with the sham-operation group,the tongue chromaticity R,G,B values of model group rats were significantly reduced(P<0.05),ECG heart rate and ST segment elevation amplitude significantly increased(P<0.05),LVEF and LVFS significantly decreased,and LVIDs and LVIDd significantly increased(P<0.05).Myocardial tissue pathology revealed that the structure was blurred,inflammatory cells infiltrated,mitochondria swelled,ruptured,and dissolved,and crista structure fracture decreased.A total of 29 potential biomarkers with significant differences between the sham-operation group and the model group were identified in metabolomics(7 upregulated and 22 downregulated),with the majority of 10 pathways enriched in thiamine metabolism,arginine biosynthesis,purine metabolism,aminoacyl-tRNA biosynthesis,alanine,aspartate and glutamate metabolism,pentose and glucuronate interconversions,glycolysis/gluconeogenesis,valine,leucine and isoleucine degradation,TCA cycle,pyruvate metabolism.Conclusion Ligation of the left anterior descending coronary artery can mimic the pathological process of coronary heart disease with blood stasis syndrome in a good way,and its pathological mechanism involves the disruption of multi-level metabolic networks such as glucose metabolism,mitochondrial energy metabolism,amino acid metabolism,protein biosynthesis,and purine metabolism.
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Objective To systematically evaluate the efficacy and safety of Compound Danshen Dripping Pills combined with conventional western medicine in the treatment of coronary heart disease complicated with diabetes mellitus.Methods Wanfang database,CNKI,VIP,SinoMed,Cochrane Library,PubMed,Embase and Web of Science databases were searched to collect randomized controlled trials(RCTs)of Compound Danshen dripping pills combined with conventional western medicine in the treatment of coronary heart disease complicated with diabetes mellitus.The retrieval time is from the establishment of the database to May 2023.Two researchers independently completed literature screening,data collation and risk of bias evaluation.RevMan 5.4 software was used for Meta-analysis.Results Twenty-four RCTs with a total of 2 546 patients were included.Meta-analysis showed that the treatment of Compound Danshen Dripping Pills combined with conventional western medicine was better than that of conventional western medicine in improving the total effective rate of coronary heart disease complicated with diabetes mellitus[OR=4.93,95%CI(3.49,6.98),P＜0.000 01],plasma adiponectin[MD= 2.79,95%CI(2.30,3.27),P＜0.000 01],reducing fasting blood glucose[SMD=-1.06,95%CI(-1.24,-0.88),P＜0.000 01],postprandial two-hour blood glucose[MD=-1.53,95%CI(-1.71,-1.35),P＜0.000 01],glycosylated hemoglobin[MD=-1.56,95%CI(-2.01,-1.11),P＜0.000 01],homocysteine[MD=-8.47,95%CI(-8.89,-7.97),P＜0.000 01],low density lipoprotein[MD=-0.46,95%CI(-0.69,-0.24),P＜0.000 01],total cholesterol[MD=-0.45,95%CI(-1.11,-0.20),P=0.005],triglycerides[MD=-0.42,95%CI(-0.50,-0.34),P＜0.000 01],interleukin 6[SMD=-1.34,95%CI(-1.61,-1.07),P＜0.000 01],cardiovascular adverse events[OR=0.35,95%CI(0.19,0.64),P=0.000 6],incidence of adverse reactions[OR=0.45,95%CI(0.24,0.86),P=0.01].Conclusion Compound Danshen Dripping Pills combined with conventional western medicine in the treatment of coronary heart disease with diabetes mellitus is more effective than conventional western medicine treatment,and with better safety.However,due to the limit of the quality of the included studies and other factors,the above conclusions still need to be verified by more high-quality clinical trials.
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Objective To investigate the impacts of matrine on the balance of helper T cell 17(Th17)/regulatory T cell(Treg)and the Ras homolog gene family member A(RhoA)-Rho-associated coiled-coil forming protein kinase(ROCK)signaling pathway in coronary heart disease(CHD)rats.Methods A model of coronary heart disease was established.Rats were grouped into control group,model group(CHD group),low-dose matrine(50 mg·kg-1,Matrine-L)group,high-dose matrine(200 mg·kg-1,Matrine-H)group,and Matrine-H+LPA(200 mg·kg-1 matrine+10 mg·kg-1 LPA)group.Echocardiography was applied to detect cardiac function.Enzyme linked immunosorbent assay(ELISA)method was used to detect interleukin-17(IL-17)and transforming growth factor(TGF-β).The quantity of Th17,Treg and Th17/Treg ratio were detected by flow cytometry.Immunohistochemistry was applied to detect the protein expressions of endothelial nitric oxide synthase(eNOS)and endothelin 1(ET-1).Masson staining was carried out to observe the pathological changes of myocardial tissue.The myocardial infarction in each group of rats was observed by TCC staining.TUNEL staining was performed to detect cell apoptosis in myocardial tissue.Additionally,RhoA activity was detected by assay kit.Western Blot method was applied to detect the protein expressions levels of B-cell lymphoma factor 2(Bcl-2),Bcl-2 associated X protein(Bax),cysteine aspartate proteinase-3(Caspase-3),RhoA,ROCK1 and ROCK2.Results Compared with the control group,a large amount of blue collagen fiber deposition was observed in the myocardial tissue of CHD group.The expression levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),IL-17,Th17,Th17/Treg,ET-1,infarct size,cell apoptosis rate,TUNEL positive rate,Bax,Caspase-3,RhoA activity,RhoA,ROCK1,ROCK2 were obviously increased.The expression levels of left ventricular ejection fraction(LVEF),left ventricular shortening fraction(LVFS),TGF-β,Treg,eNOS,and Bcl-2 were obviously reduced(P＜0.05).Compared with the CHD group,blue collagen fibers in myocardial tissue of Matrine-L and Matrine-H groups gradually decreased.The expression levels of LVEDV,LVESV,IL-17,Th17,Th17/Treg,ET-1,infarct size,cell apoptosis rate,TUNEL positive rate,Bax,Caspase-3,RhoA activity,RhoA,ROCK1 and ROCK2 were obviously reduced in sequence.The expression levels of LVEF,LVFS,TGF-β,Treg,eNOS,and Bcl-2 were also obviously increased in sequence(P＜0.05).Compared with the Matrine-H group,blue collagen fibers in myocardial tissue of Matrine-H+LPA group increased.The expression levels of LVEDV,LVESV,IL-17,Th17,Th17/Treg,ET-1,infarct size,cell apoptosis rate,TUNEL positive rate,Bax,Caspase-3,RhoA activity,RhoA,ROCK1,ROCK2 were obviously increased,while the expression levels of LVEF,LVFS,TGF-β,Treg,eNOS and Bcl-2 were obviously reduced(P＜0.05).Conclusion Matrine regulates Th17/Treg cell balance and improves myocardial injury in rats with CHD by inhibiting the RhoA-ROCK signaling pathway.
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Objective To probe into the mechanism of Shexiang Baoxin Pill in homo-therapy for heteropathy for type 2 diabetes mellitus （T2DM） and coronary heart disease （CHD） based on network pharmacology. Methods All chemical components and action targets of these seven traditional Chinese medical in Shexiang Baoxin Pill were screened by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）, Traditional Chinese Medicines Integrated Database （TCMID）, The Encyclopedia of Traditional Chinese Medicine （ETCM） and BATMAN-TCM platform, and the DisGeNET and GeneCards databases were used to obtain CHD and T2DM-related Disease targets. The “drug-component-target” network map was constructed by Cytoscape 3.8.2 software, the protein-protein interaction （PPI） network map was constructed by STRING database, and the GO biological process analysis and KEGG pathway enrichment analysis were performed on the common targets of Shexiang Baoxin Pill for T2DM and CHD using DAVID online database. Results A total of 101 potential active ingredients for the treatment of T2DM and CHD in Shexiang Baoxin Pill were screened out, corresponding to 229 targets. Network analysis results showed that the common main active ingredients in Shexiang Baoxin Pill for treating T2DM and CHD might be chenodeoxycholic acid, ursodeoxycholic acid, cinnamic aldehyde, bile acids, cinnamic acid, and ginsenosides. The results of pathway enrichment analysis showed that the mechanism of action of Shexiang Baoxin Pill in the treatment of type 2 diabetes and coronary heart disease in treating T2DM and CHD might be related to the inhibition of inflammatory response and oxidative stress. Conclusion Shexiang Baoxin Pill could play a role in treating CHD and T2DM through multiple components, multiple targets and multiple pathways, which provided a certain theoretical basis for the clinical application and further research of Shexiang Baoxin Pill.
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Objective @#To clarify the distribution of traditional Chinese medicine (TCM) pattern and its associated risk factors after percutaneous coronary intervention (PCI), and evaluate the reporting quality of existing studies to guide future research standardization.@*Methods@#English databases including PubMed, Cochrane Library, and Web of Science, as well as Chinese databases including China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (VIP), and Wanfang Database were searched to retrieve papers about PCI. The time span for the paper retrieval was set from the foundation of the databases to October 1, 2023. Statistical analyses were performed using Stata 12 and Python (V 3.9). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was used to assess the reporting quality of included studies.@*Result@#Overall, 1 356 articles were selected, and 40 cross-sectional studies were included with 10 270 participants. The most common TCM patterns before, one to two weeks after, and six months to one year after PCI was Qi stagnation and blood stasis (n = 261, 36.45%), intertwined phlegm and blood stasis (n = 109, 27.18%), and Qi deficiency and blood stasis (n = 645, 37.03%), respectively. Smoking [odds ratio (OR) = 1.15, 95% confidence interval (CI) (0.83 – 1.47), I 2 = 24.7%, P = 0.257], pattern of congealing cold and Qi stagnation [OR = 4.62, 95% CI (1.37 – 7.86), I 2 = 61.6%, P = 0.074], and low-density lipoprotein (LDL) [OR = 1.38, 95% CI (0.92 – 1.85), I 2 = 12.2%, P = 0.286] were risk factors for restenosis. Hypertension [OR = 7.26, 95% CI (3.54 – 14.88), I 2 = 91.6%, P = 0.001], and overweight [i.e., body mass index (BMI) > 23] [OR = 1.20, 95% CI (1.07 – 1.35), I 2 = 85.3%, P = 0.009] were significant risk factors of concomitant anxiety.@*Conclusion@#This systematic review andet a-analysis revealed that patients with different TCM pattern types have distinct characteristics and risk factors after PCI. More high-qualitystudies are warranted to provide supportive evidence for future research and clinical practice.
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Background Ozone (O3) pollution has gradually become a primary problem of air pollution in recent years. Conducting epidemiological studies on the correlation between O3 concentration variation and risk of cardiovascular and cerebrovascular diseases can provide reference data for O3 risk assessment and related policy making. Objective To quantitatively evaluate the effects of O3 exposure on mortalities of cardiovascular and cerebrovascular diseases among residents in Minhang District, Shanghai. Methods Data of mortalities of cardiovascular and cerebrovascular diseases, air pollutants, and meteorological factors in Minhang District of Shanghai from January 1, 2016 to December 31, 2021 were collected. Associations between O3 concentration and the mortalities due to total cardiovascular and cerebrovascular diseases, coronary heart disease, and stroke were analyzed by generalized additive models with a quasi Poisson distribution with different lag patterns, such as current day effect (lag0), single-day lag effects (lag1-lag3), and cumulative lag effects (lag01-lag03). The subgroup analyses of age, sex, and season were conducted. Furthermore, temperature was divided into low, middle, and high levels based on the 25th percentile (P25) and the 75th percentile (P75) to perform hierarchical analyses. Increased excess risks (ER) of death from target diseases caused by a 10 µg·m−3 increase in daily maximum 8 h concentration of O3 (O3-8 h) and their 95% confidence intervals (CI) were used to indicate the effects of O3. Results The associations between O3 and the risks of death from cardiovascular and cerebrovascular diseases were statistically significant at lag2, lag3, lag02, and lag03 (P<0.05), with the greatest effect size observed at lag03. The ER values of death from cardiovascular and cerebrovascular diseases in general population, male residents, and people aged 65 years and older, from coronary heart disease in male residents, and from stroke in general population increased by 1.02% (95%CI: 0.36%, 1.69%), 1.40% (95%CI: 0.47%, 2.34%), 0.87% (95%CI: 0.19%, 1.55%), 1.96% (95%CI: 0.49%, 3.44%), and 1.02% (95%CI: 0.07%, 1.98%) for a 10 µg·m−3 increase in O3-8 h concentration at lag03, respectively. During the warm season (from April 1 to September 30), the ER values of death from cardiovascular and cerebrovascular diseases and coronary heart disease per 10 µg·m−3 increase in O3 were 1.18% (95%CI: 0.33%, 3.33%) and 2.69% (95%CI: 0.39%, 5.03%), while the O3 effect was only statistically significant on cardiovascular and cerebrovascular diseases during the cold season (from October 1 to March 31 next year). At the middle and high temperature levels, the ER values of death from cardiovascular and cerebrovascular diseases increased by 1.63% (95%CI: 0.32%, 2.96%) and 1.14% (95%CI: 0.17%, 2.12%) respectively. The two-pollutant models showed similar results after including other pollutants (carbon monoxide, nitrogen dioxide, sulfur dioxide, fine particulate matter, or inhalable particulate matter). Conclusion Ambient O3 pollution may increase the mortality risks of cardiovascular and cerebrovascular diseases, coronary heart disease, and stroke in Minhang District of Shanghai.
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ObjectiveTo investigate the objective characteristics of tongue manifestations in patients with coronary heart disease （CHD）. MethodsA total of 315 participants with CHD were recruited in the CHD group， and 211 healthy participants who underwent physical examination were recruited as the healthy control group. In addition， according to the common comorbidities （primary hypertension， carotid atherosclerosis， type 2 diabetes mellitus， fatty liver， hyperlipidaemia， heart failure， and cerebral infarction） in 315 participants with CHD， each comorbidity was classified into a group of comorbidities with that disease and a group of non-comorbidities. Tongue images were captured using a TFDA-1 tongue diagnostic instrument to characterise the tongue body （TB） and tongue coating （TC）， comparing the RGB， HIS， and Lab colour spaces in the chromaticity index （R， red； G， green； B， blue； H， hue； I， intensity； S， saturation； L， lightness； a， red-green axis； b， yellow-blue axis）， the tongue coating thickness index （per-All）， contrast （CON）， angular second moment （ASM）， entropy （ENT）， and mean （MEAN） in texture metrics. ResultsCompared with the healthy control group， the characteristic indexes of tongue body in CHD group showed lower TB-R， TB-G， TB-B， TB-I， TB-L and higher TB-H， TB-b； and the characteristic indexes of tongue coating in CHD group showed lower TC-R， TC-B and higher TC-CON， TC-MEAN， TC-H， TC-b （P＜0.05 or P＜0.01）. Compared with non-combined primary hypertension group， CHD combined primary hypertension group showed higher per-All， TB-G， TB-L， and lower TB-a， TC-a （P＜0.05）； compared with the non-combined carotid atherosclerosis group， CHD combined carotid atherosclerosis group showed higher TB-CON， TB-ENT， TB-MEAN， and lower TB-ASM （P＜0.05 or P＜0.01）； compared with the non-combined type 2 diabetes mellitus group， CHD combined type 2 diabetes mellitus group showed lower per-All and higher TB-H （P＜0.05 or P＜0.01）； compared with the non-combined fatty liver group， CHD combined fatty liver group showed higher TB-CON， TB-MEAN， TB-ENT， and lower TB-ASM and TC-S （P＜0.05 or P＜0.01）； compared with the non-combined hyperlipidaemia group， CHD combined hyperlipidaemia group showed lower TB-S and TB-a （P＜0.05）； compared with non-combined heart failure group， CHD combined heart failure group showed lower TB-R， TB-G， TB-I， TB-L， and higher TB-a （P＜0.05 or P＜0.01）； compared with non-combined cerebral infarction group， CHD combined cerebral infarction group showed higher TC-CON， TC-ENT， TC-MEAN， and lower TC-ASM （P＜0.05 or P＜0.01）. ConclusionCompared to healthy individuals， patients with CHD tend to have darker tongue colours and rougher TC textures. Compared with non-comorbidity participants， those with primary hypertension tended to be lighter tongue colour and thicker tongue coating， those with carotid atherosclerosis had paler tongue body， those with type 2 diabetes mellitus had thinner tongue coating， those with fatty liver disease had paler tongue body and whiter tongue colour， those with hyperlipidaemia and heart failure had paler tongue colour， and those with cerebral infarction had rougher tongue texture.
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This study explored the comorbidity mechanisms of coronary heart disease and depression from the perspectives of "constraint causing disease" and "disease causing constraint"， for which "constraint" is the link， and the key lies in the stagnation of qi. The heart storing manifestations in traditional Chinese medicine （TCM） encompasses most physiological processes of the circulatory system， the mental nervous system， and some functions of the endocrine system， and cardiovascular diseases and psychological disorders are closely related to it. In TCM， it is proposed that the stagnation of heart yang leading to "yang deficiency" is the pathogenesis of chest tightness， and emotional disturbance leading to the stagnation of yang qi aggravates the chest tightness， reflecting the process of "disease causing constraint". As the disease progresses， the appearance of phlegm and stasis further worsens the condition， reflecting the process of "constraint causing disease". Based on modern medical understanding， the abnormal accumulation of lipids， platelets， oxidative products， cytokines， and other substances constitute a form of "constraint"， which is also the material basis for the comorbidity of coronary heart disease and depression. These substances promote neuronal damage or apoptosis in the emotional and cognitive regions， inducing the onset of depression， reflecting the process of "disease causing constraint". Meanwhile， adverse emotions lead to sympathetic nerve excitement， resulting in the production of catecholamines， promoting platelet aggregation， elevating levels of inflammatory markers， and increasing the risk of coronary heart disease， reflecting the process of "disease causing constraint".
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ObjectiveTo investigate the effect of remnant cholesterol （RC）/high-density lipoprotein cholesterol （HDL-C） ratio on coronary computed tomography-derived fractional flow reserve （FFRct） in coronary heart disease （CHD） patients with critical lesions. MethodsA retrospective study was done on patients who were admitted to our department and underwent coronary computed tomography angiography （CCTA） from January 1， 2022 to December 31， 2022. All the 304 culprit vessels from the 219 patients with moderate coronary artery stenosis （50%~70%） were divided into FFRct ischemia group （FFRct≤0.8， N=108） and FFRct non-ischemia group （FFRct>0.8， N=111）. Multivariate logistic regression analysis was used to explore the influencing factors of FFRct≤0.8 in CHD patients with critical lesions. Receiver operating characteristic （ROC） curve was drawn to evaluate the predictive value of RC/HDL-C for FFRct≤0.8. Pearson correlation analysis was used to assess whether there was a correlation between RC/HDL-C and FFRct. ResultsThere were significantly more diabetic patients in FFRct ischemia group （P<0.001）. RC/HDL-C ratio， levels of RC， non-HDL-C， APOB， HbA1c and FPG in FFRct ischemic group were significantly increased （P<0.05）. Pearson correlation analysis showed that the RC/HDL-C ratio， levels of RC， Non-HDL-C， TC， TG， LDL-C， HDL-C， LP（a）， HbA1c， and FPG were all significantly negatively correlated with FFRct values （P<0.05）. Univariate logistic regression analysis showed that diabetes mellitus， RC/HDL-C ratio， levels of RC， non-HDL-C， TG， LP（a）， HbA1c and FPG were significantly correlated with FFRct≤0.8 （P<0.05）. Multivariate logistic regression analysis showed that RC/HDL-C ratio was a predictor of FFRct≤0.80 （OR=4.682， 95%CI 1.197~18.316， P<0.05）. ConclusionsRC/HDL-C ratio is independently correlated with FFRct≤0.8 in CHD patients with moderate stenosis and it is a potential indicator for evaluating coronary functional ischemia.
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This paper summarized Professor ZHANG Junping's clinical experience in treating coronary heart disease （CHD） combined with hypothyroidism. It is believed that yang deficiency was the root cause of CHD complicated with hypothyroidism， and also the key pathogenesis throughout its development. Accordingly， combined with the different focuses on the lesions in the blood， pulse， heart and spirit， Professor ZHANG took warming yang as the basic rule and summarized the four methods of warming yang for syndrome differentiation and treatment. When spleen-kidney yang deficiency， disturbance of qi transformation， dysfunction of blood transportation as the pathological basis of CHD combined with hypothyroidism， the self-prescribed Butian Formula （补天方） could be used for warming yang and benefiting the kidney， thereby regulating Qi and blood； when the cold and dampness blocked the blood vessels， and turbidity-toxin generated gradually， resulting in heart vessel obstruction， the self-prescribed Huazhuo Changmai Decoction （化浊畅脉汤） could be used to warm yang and dissolve the turbidity so that to unblock the heart vessels； when the structure and function of the heart fail， edema due to yang deficiency with pericardial fluid retention， the self-prescribed Yuxin Baomai Formula （育心保脉方） could be used to warm yang and excret water， and protect the heart； when yang deficiency led to emotional and mental stagnation， and the heart impairment aggravated emotional and mental disorders， which resulted in emotional and mental abnormalities， the self-prescribed Jieyu Anshen Decoction （解郁安神汤） could be used to relieve emotional and mental stagnation， and calm mind.
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OBJECTIVE To observe the efficacy of vericiguat in the treatment of acute decompensated heart failure （HF） and its effect on left ventricular ejection fraction （LVEF） in patients with different left ventricular end-diastolic internal diameters （LVDd）. METHODS A total of 52 patients with acute decompensated HF who were hospitalized in Anqing Municipal Hospital from September 2022 to May 2023 and were stabilized by intravenous injection of diuretics or vasodilators and then given vericiguat orally were selected. Clinical baseline data were collected， and blood creatinine （Scr）， estimated glomerular filtration rate （eGFR）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， echocardiographic indexes（LVEF， LVDd）， and Kansas City cardiomyopathy questionnaire （KCCQ） scores and so on were recorded and analyzed at 1 and 6 months after treatment. The patients were divided into two subgroups according to whether they had dilated cardiomyopathy or not， the baseline data were compared between the two subgroups， and the changes in the above follow-up indexes for the entire population and two subgroups of patients were analyzed by using mixed effect model. RESULTS Patients in the dilated cardiomyopathy group were significantly younger than those in the nondilated cardiomyopathy group， while the former had a lower proportion of patients with combined coronary artery disease， longer LVDd， lower LVEF levels， and more HF patients with reduced ejection fraction （P＜0.05）. Compared with baseline values， KCCQ scores were significantly higher in patients in the whole population， non-dilated cardiomyopathy group and dilated cardiomyopathy group at 1 month after treatment （P＜0.001）. The difference between the whole population in terms of elevated KCCQ scores and decreased lg（NT-proBNP） levels was statistically significant at 6 months after treatment （P＜0.05）； the levels of lg（NT-proBNP）of two subgroups were significantly decreased and KCCQ scores were significantly increased （P＜0.05）， but the difference was not statistically significant （P＞0.05）； LVEF levels of the patients E-mail：guangf4-508@163.com in both subgroups were significantly elevated （P＜0.05） and the difference between the subgroups amounted to 7.52% （P＝0.030）. Mixed effect model result showed that whether patients had coronary artery disease and different baseline levels of LVDd were likely to affect follow-up LVEF levels， with coronary artery disease contributing to follow-up LVEF elevation （P＝0.043）， but the coronary artery disease subgroup × time interaction was not significant （P＞0.05）；compared with patients with baseline LVDd ≥62 mm， patients with baseline LVDd≤61 mm had a faster LVEF improvement （P＜0.05）. CONCLUSIONS Vericiguat is able to improve cardiac function and quality of life in patients with acute decompensated HF without negatively affecting their renal function. The drug is able to significantly improve LVEF levels in patients with baseline LVDd ≤61 mm.
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OBJECTIVE To observe the efficacy of vericiguat in the treatment of acute decompensated heart failure （HF） and its effect on left ventricular ejection fraction （LVEF） in patients with different left ventricular end-diastolic internal diameters （LVDd）. METHODS A total of 52 patients with acute decompensated HF who were hospitalized in Anqing Municipal Hospital from September 2022 to May 2023 and were stabilized by intravenous injection of diuretics or vasodilators and then given vericiguat orally were selected. Clinical baseline data were collected， and blood creatinine （Scr）， estimated glomerular filtration rate （eGFR）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， echocardiographic indexes（LVEF， LVDd）， and Kansas City cardiomyopathy questionnaire （KCCQ） scores and so on were recorded and analyzed at 1 and 6 months after treatment. The patients were divided into two subgroups according to whether they had dilated cardiomyopathy or not， the baseline data were compared between the two subgroups， and the changes in the above follow-up indexes for the entire population and two subgroups of patients were analyzed by using mixed effect model. RESULTS Patients in the dilated cardiomyopathy group were significantly younger than those in the nondilated cardiomyopathy group， while the former had a lower proportion of patients with combined coronary artery disease， longer LVDd， lower LVEF levels， and more HF patients with reduced ejection fraction （P＜0.05）. Compared with baseline values， KCCQ scores were significantly higher in patients in the whole population， non-dilated cardiomyopathy group and dilated cardiomyopathy group at 1 month after treatment （P＜0.001）. The difference between the whole population in terms of elevated KCCQ scores and decreased lg（NT-proBNP） levels was statistically significant at 6 months after treatment （P＜0.05）； the levels of lg（NT-proBNP）of two subgroups were significantly decreased and KCCQ scores were significantly increased （P＜0.05）， but the difference was not statistically significant （P＞0.05）； LVEF levels of the patients E-mail：guangf4-508@163.com in both subgroups were significantly elevated （P＜0.05） and the difference between the subgroups amounted to 7.52% （P＝0.030）. Mixed effect model result showed that whether patients had coronary artery disease and different baseline levels of LVDd were likely to affect follow-up LVEF levels， with coronary artery disease contributing to follow-up LVEF elevation （P＝0.043）， but the coronary artery disease subgroup × time interaction was not significant （P＞0.05）；compared with patients with baseline LVDd ≥62 mm， patients with baseline LVDd≤61 mm had a faster LVEF improvement （P＜0.05）. CONCLUSIONS Vericiguat is able to improve cardiac function and quality of life in patients with acute decompensated HF without negatively affecting their renal function. The drug is able to significantly improve LVEF levels in patients with baseline LVDd ≤61 mm.
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The key pathogenesis of coronary heart disease （CHD） is spleen deficiency and phlegm stasis， and dysfunctional high-density lipoprotein （dys-HDL） may be the biological basis for the occurrence of CHD due to spleen deficiency and phlegm stasis. Considering the biological properties and effects of high-density lipoprotein （HDL）， it is believed that the structure and components of HDL are abnormal in the state of spleen deficiency which led to dys-HDL； and dys-HDL contributes to the formation of atherosclerotic plaques through two major pathways， namely， mediating the dysfunction of endothelial cells and mediating the foaminess of macrophages and smooth muscle cells， thus triggering the development of CHD. It is also believed that dys-HDL is a microcosmic manifestation and a pathological product of spleen deficiency， and spleen deficiency makes foundation for the production of dys-HDL； dys-HDL is also an important biological basis for the phlegm-stasis interactions in CHD. The method of fortifying spleen， resolving phlegm， and dispelling stasis， is proposed as an important principle in the treatment of CHD by traditional Chinese medicine， which can achieve the therapeutic purpose by affecting the changes in the structure and components of dys-HDL， thus revealing the scientific connotation of this method， and providing ideas for the diagnosis and treatment of CHD by traditional Chinese medicine.
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Objective To establish an individual Nomgram model for predicting the risk of coronary heart disease complicated with pulmonary hypertension. Methods From January 2017 to December 2021 , 352 patients with coronary heart disease (CHD) complicated with pulmonary hypertension in our hospital were selected, and 352 patients with coronary heart disease but without pulmonary hypertension were selected as the control group. The clinical baseline data of the two groups were analyzed first, and then logistics multivariate analysis was performed. To explore the risk factors of coronary heart disease complicated with pulmonary hypertension, the Nomgram model was established to predict the risk, and the predictive value of the model was tested by receiver characteristic curve (ROC). Results Logistics multivariate analysis showed that alcoholism, smoking, stroke history, hypertension course, CHD course, PASP, HCT, PaCO2, D-dimer, NIHSS score and low PaO2 were all independent risk factors for CHD complicated with pulmonary hypertension. Nomgram model prediction results for patients with coronary heart disease showed that Alcohol abuse, smoking, stroke history, duration of hypertension (5.66 years), duration of coronary heart disease (2.12 years), NIHSS (12.33 points), PASP (75.22mmHg), HCT (33.22%), PaCO2 (56.11mmHg), D-dimer (255.12μg/L), PaO2 (56.22mmHg) is a risk factor for coronary heart disease complicated with pulmonary hypertension. ROC curve showed that the area under the prediction curve of Nomgram model for coronary heart disease complicated with pulmonary hypertension was 0.675. Conclusion Nomgram model can predict pulmonary hypertension in patients with coronary heart disease to a certain extent.