Automated Analysis of Doppler Echocardiographic Videos as a Screening Tool for Valvular Heart Diseases.

OBJECTIVES: This study sought to develop a deep learning (DL) framework to automatically analyze echocardiographic videos for the presence of valvular heart diseases (VHDs). BACKGROUND: Although advances in DL have been applied to the interpretation of echocardiograms, such techniques have not been reported for interpretation of color Doppler videos for diagnosing VHDs. METHODS: The authors developed a 3-stage DL framework for automatic screening of echocardiographic videos for mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), and aortic regurgitation (AR) that classifies echocardiographic views, detects the presence of VHDs, and, when present, quantifies key metrics related to VHD severities. The algorithm was trained (n = 1,335), validated (n = 311), and tested (n = 434) using retrospectively selected studies from 5 hospitals. A prospectively collected set of 1,374 consecutive echocardiograms served as a real-world test data set. RESULTS: Disease classification accuracy was high, with areas under the curve of 0.99 (95% CI: 0.97-0.99) for MS; 0.88 (95% CI: 0.86-0.90) for MR; 0.97 (95% CI: 0.95-0.99) for AS; and 0.90 (95% CI: 0.88-0.92) for AR in the prospective test data set. The limits of agreement (LOA) between the DL algorithm and physician estimates of metrics of valve lesion severities compared to the LOAs between 2 experienced physicians spanned from -0.60 to 0.77 cm2 vs -0.48 to 0.44 cm2 for MV area; from -0.27 to 0.25 vs -0.23 to 0.08 for MR jet area/left atrial area; from -0.86 to 0.52 m/s vs -0.48 to 0.54 m/s for peak aortic valve blood flow velocity (Vmax); from -10.6 to 9.5 mm Hg vs -10.2 to 4.9 mm Hg for average peak aortic valve gradient; and from -0.39 to 0.32 vs -0.31 to 0.32 for AR jet width/left ventricular outflow tract diameter. CONCLUSIONS: The proposed deep learning algorithm has the potential to automate and increase efficiency of the clinical workflow for screening echocardiographic images for the presence of VHDs and for quantifying metrics of disease severity.

Five-year Clinical Outcomes of CAD Patients Complicated with Diabetes after StentBoost-optimized Percutaneous Coronary Intervention.

Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention (PCI). Methods From March 2009 to July 2010, 184 patients undergoing PCI at our hospital were found stent underexpansion or malapposition by StentBoost after stents implantation and were divided into the diabetic (n=73, 39.67%) and the non-diabetic group (n=111, 60.33%). All patients received StentBoost-guided post-dilatation after stent implantation. The instant procedural results were measured and clinical outcome after five-year follow-up was analyzed in each group. Between-group comparisons were performed using Chi-square test or Student's t test. Multivariate logistic regression analysis was carried out to reveal the independent predictors for long-term clinical outcomes of StentBoost-optimized PCI . Results After StentBoost-guided post-dilatation, the minimum diameter (MinLD), maximum diameter (MaxLD) and average diameter in both groups increased significantly than before (P<0.001), the (MaxLD-MinLD)/MaxLD ratio and the in-stent residual stenosis decreased accordingly (P<0.001). The five-year follow-up showed similar mortality rate (4.92% vs. 2.86%, P=0.67) and major adverse cardiac event rate (11.48% vs. 11.43%, P = 1.0) between the diabetic and the non-diabetic group, whereas the recurrence of angina pectoris was higher in the diabetic group compared to the non-diabetic group (47.54% vs. 29.52%; P=0.02). A multivariate logistic regression analysis revealed that age and left ventricular ejection fraction rather than diabetes mellitus were independent predictors for long-term clinical outcomes. Conclusions StentBoost could effectively improve instant PCI results; the long-term clinical outcomes of StentBoost-optimized PCI were similar between diabetic and non-diabetic patients. Age and left ventricular ejection fraction were the independent predictors for long-term clinical outcomes.

Fatal myocarditis and rhabdomyolysis induced by nivolumab during the treatment of type B3 thymoma.

Immune checkpoint inhibitors including programmed death-1 inhibitors are promising agents for many types of malignancies; however, it is still an off-label choice for type B3 thymoma. We reported for the first time a patient with type B3 thymoma developed fatal myocarditis and rhabdomyolysis after one dose of nivolumab administration. The results from myocardial and muscle biopsies revealed extensive myocyte damage, T-lymphocytic infiltration and strongly expression of PD-L1 which confirmed the nivolumab-related immune-related adverse events (irAEs). The blood tests showed elevated levels of serum AChR-binding antibody and inflammatory cytokines, in addition abnormal lymphocyte subsets were noted. Our report suggested that administration of nivolumab in type B3 thymoma could cause rare but fatal myocarditis and rhabdomyolysis, over-expressed AChR-binding antibody and inflammatory cytokines may be potential biomarkers for irAEs.

The application of lung ultrasound in acute decompensated heart failure in heart failure with preserved and reduced ejection fraction.

OBJECTIVES: Lung ultrasound detection of B-lines has become a simple, semiquantitative, noninvasive tool for evaluating pulmonary congestion in heart failure (HF) patients. This study compared the correlation of B-lines with E/e', NT-proBNP, and ejection fraction (EF) in acute decompensated heart failure (ADHF). METHODS: Eighty-two consecutive patients who were diagnosed with acute decompensated HF were divided into two groups: preserved ejection fraction heart failure (HFpEF, EF≥50%, n=32) and reduced ejection fraction heart failure (HFrEF, EF<50%, n=50). Spearman's correlation was used to evaluate associations of B-lines with E/e', NT-proBNP, and EF in the two groups. Receiver operating characteristic (ROC) analysis was performed to compare B-lines with the E/e' ratio. RESULTS: Results revealed no significant differences were observed in the B-lines between the HFpEF and HFrEF groups. However, compared with the control group, B-lines were significantly increased in the HFpEF and HFrEF groups (P<.05). The B-lines were positively correlated with E/e' (r=0.742, r=0.52) and NT-proBNP (r=0.678, r=0.417) but were negatively correlated with EF (r=-0.365, r=-0.337), and the correlation coefficients were higher in the HFpEF group than in the HFrEF group. In ROC analyses, considering E/e' ≥14 as a reference, B-lines yielded a C-statistic value of 0.94 (sensitivity 92%, specificity 83%) in the HFpEF group and 0.84 (sensitivity 86%, specificity 78%) in the HFrEF group. CONCLUSIONS: B-lines were significantly correlated with the more established parameters of ADHF. The correlation between B-lines and E/e' was better, especially in the HFpEF group.

Detection of very delayed coronary stent fracture using a novel fluoroscopic stent visualization technique against intravascular ultrasound: A case series.

RATIONALE: Stent fracture has received increased concern as it may be an important risk factor for late stent failure, intravascular ultrasound (IVUS) is always recommended to confirm the diagnosis of stent fracture. StentBoost can detect stent fractures more easily due to the enhanced stent strut visibility, compared with coronary angiography (CAG). Few cases were reported to compare the advantages of StentBoost vis-à-vis IVUS in detecting stent fracture. PATIENT CONCERNS: We reported 3 cases that were confirmed the diagnosis of stent fracture by StentBoost, which were preliminarily suspected by angiography, including one case that lacked the IVUS evidence of stent fracture. DIAGNOSES: 3 cases of stent fracture presented with asymptomatic, angina and acute myocardial infarction, respectively. INTERVENTION: Stents were implanted in the patients of case 2 and case 3, but the patient of case 1 was not given any intervention. OUTCOMES: No recurrent angina or myocardial infarction during outpatient follow-up. LESSONS: StentBoost may distinguish partial, complete, or multiple stent fracture, even which sometimes is not obvious in IVUS, StentBoost is a useful and handy tool for identifying the stent struts.

Association Between Serum Uric Acid Levels and Atrial Fibrillation Risk.

BACKGROUND: Several studies were published to assess the association between serum uric acid levels and atrial fibrillation risk, but no consistent results were reported. We performed a meta-analysis to evaluate the evidence of the association between hyperuricemia and atrial fibrillation risk. MATERIAL/METHODS: Pubmed and Embase databases were searched for prospective cohort studies assessing the association between hyperuricemia and atrial fibrillation risk. Relative risks (RRs) with corresponding 95% confidence intervals (95%CIs) were pooled using random-effect of meta-analysis to assess the risk of atrial fibrillation in individuals with hyperuricemia. RESULTS: Six cohort studies were finally included into the meta-analysis. Meta-analysis of those 6 studies showed that hyperuricemia was significantly associated with increased risk of atrial fibrillation (RR = 1.49, 95%CI 1.24-1.79, P < 0.001). Sensitivity analysis by omitting single study sequentially by turns did not have any obvious influence on the pooled risk estimates. There was no obvious risk of publication bias in the meta-analysis. CONCLUSIONS: Based on the currently available data, hyperuricemia is associated with increased risk of atrial fibrillation.

Long Noncoding RNA Highly Upregulated in Liver Cancer Regulates the Tumor Necrosis Factor-α-Induced Apoptosis in Human Vascular Endothelial Cells.

Atherosclerosis is the major cause of myocardial infarction and stroke, which is a leading cause of morbidity and mortality in developed countries. During the pathological process of atherosclerosis, inflammation participates in all stages of atherosclerosis. Tumor necrosis factor-α (TNF-α), one of the most important inflammatory factor, induces apoptosis of endothelial cells, which play a central role in endothelial dysfunction. However, the underlying mechanism involved in long noncoding RNA (lncRNA) remains unclear. In the present study, we demonstrated the role of lncRNA highly upregulated in liver cancer (HULC) in TNF-α-induced apoptosis. HULC expression was decreased with TNF-α treatment. Restoring HULC expression rescued the apoptosis induced by TNF-α. HULC regulated TNF-α-induced apoptosis through regulation of miR-9 expression. Furthermore, RNA immunoprecipitation and RNA pull-down assays showed that HULC modulated miR-9 expression through association with DNA methyltransferases and suppression of miR-9 expression. HULC-miR-9 pathway may be a potential target for treating atherosclerosis.

Meta-Analysis on the Correlation Between APOM rs805296 Polymorphism and Risk of Coronary Artery Disease.

BACKGROUND: The present meta-analysis aimed to summarize the inconsistent findings on the association of apolipoprotein M gene (ApoM) rs805296 polymorphism with the risk of coronary artery disease (CAD), and to obtain a more authentic result about this topic. MATERIAL/METHODS: A total of 7 available articles were identified through electronic databases--PubMed, EMBASE, and Chinese National Knowledge Infrastructure (CNKI)--and their useful data were carefully extracted. The relationship between ApoM rs805296 polymorphism and CAD risk was assessed by odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs), which were calculated using the fixed- or random-effects model, according to the degree of heterogeneity. Hardy-Weinberg equilibrium test, sensitivity test, and publication bias examination were also performed in this meta-analysis. RESULTS: According to the pooled results, ApoM rs805296 polymorphism conferred an increased risk of CAD under all the genetic contrasts: CC versus TT, CC + TC versus TT, CC versus TT+TC, C versus T, and TC versus TT (OR=2.13, 95% CI=1.16-3.91; OR=1.80, 95% CI=1.50-2.17; OR=1.91, 95% CI=1.04-3.51; OR=1.72, 95% CI=1.45-2.04; OR=1.78, 95% CI=1.47-2.15). CONCLUSIONS: ApoM rs805296 polymorphism may be a risk factor for developing CAD.

Brain Natriuretic Peptide as the long-term cause of mortality in patients with cardiovascular disease: a retrospective cohort study.

OBJECTIVE: To explore the influence of BNP (Brain Natriuretic Peptide) in plasma on the long-term cause of mortality and prognosis of patients with cardiovascular disease (CVD). METHOD: We performed a retrospective cohort study of 276 inpatients that enrolled in our hospital from March 2003 to December 2004 and had a history of heart disease and received a BNP test. Kaplan-Meier survival curves with Log-Rank test were used to compare the survival rates among different levels of BNP (<100 ng/L, 101~1000 ng/L, 1001~5000 ng/L and >5000 ng/L). Cox proportional hazards regression models were used to estimate HRs and 95% CIs with adjustments for other covariance's. RESULT: After a median follow-up of 7 years, a total of 91 patients died of whom fifty were cardiogenic deaths and 41 were non-cardiogenic. The survival rates were of statistical significance (P=0.0000) between the different levels of BNP in the 4 groups, and the mortality rate increased gradually with the increase in BNP concentration. Multivariable Cox regression analysis showed that BNP levels were inversely associated with the survival rate in CVD patients (HR=0.24, 95% CI: 0.13~0.42). In addition, age and left ventricular ejection fraction values were also of statistical significance in the Cox regression model. CONCLUSION: Our findings suggested that high Plasma BNP levels may have an adverse effect on the prognosis of patients with cardiovascular disease.

Evaluation of myocardial infarction size with three-dimensional speckle tracking echocardiography: a comparison with single photon emission computed tomography.

To assess whether global and regional myocardial strains from three-dimensional speckle tracking echocardiography (3D-STE) correlate with myocardial infarction size (MIS) detected by single photon emission computed tomography (SPECT). Fifty-seven patients with a history of ST-segment elevation myocardial infarction (MI) within 3-6 months were enrolled, alongside 24 healthy volunteers. Left ventricular (LV) global area strain, global longitudinal strain (GLS), global radial strain, global circumferential strain, left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were measured and compared with the corresponding SPECT-detected MISs. Patients were sub-grouped into massive MIS group (MIS ≥ 12%) and small MIS group (MIS < 12%). Myocardial strains of all the LV segments were compared with the corresponding MIS. Global myocardial strain parameters, LVEF and WMSI of the patients were significantly different from the control group (all P < 0.05) and correlated well with MISs, most significantly for GLS (r = 0.728, P < 0.01). Significant differences in myocardial strain parameters were found between the massive and small MIS groups (all P < 0.05). Receiver operating characteristic curve analysis indicated that GLS had a highest diagnostic value and when the cutoff was -13.8%, the area under the curve was 0.84, with the 70.6% sensitivity and 87.5% specificity. Significant differences of myocardial strain parameters were observed between segments with and without transmural MIs (P < 0.01). 3D-STE myocardial strain parameters evaluated LV global MIS, 3D GLS had the highest diagnostic value. It also preliminarily gauged the degree of ischemia and necrosis of regional myocardial segments.

Assessment of Myocardial Infarct Size by Three-Dimensional and Two-Dimensional Speckle Tracking Echocardiography: A Comparative Study to Single Photon Emission Computed Tomography.

OBJECTIVE: To compare three-dimensional (3D) and two-dimensional (2D) speckle tracking echocardiography (STE) techniques in the assessment of left ventricular function and myocardial infarct size (MIS). METHODS: Thirty-two patients diagnosed with ST elevation myocardial infarction and 18 healthy control patients underwent 2D echocardiography, 3D echocardiography, and single photon emission computed tomography (SPECT). 3D left ventricular global area strain (GAS), 2D and 3D global longitudinal strain (GLS), global radial strain (GRS) as well as global circumferential strain (GCS) were analyzed to correlate with myocardial infarct size detected by SPECT. 2D and 3D left ventricular ejection fraction (LVEF) as well as 2D and 3D wall motion score index (WMSI) also were measured using conventional echocardiography. RESULTS: The 2D-GLS values were significantly higher than that of 3D-GLS, while 2D-GCS and GRS were significantly lower than 3D-GCS and GRS, respectively. However, no significant differences in LVEF and WMSI could be observed between 2D and 3D echocardiography. Myocardial strain indices, LVEF, and WMSI using 2D and 3D echocardiography also had good correlations with MIS as measured by SPECT. ROC curve analysis showed that the 3D and 2D myocardial indices, LVEF, and WMSI could distinguish between small and large MIS, while 2D-GLS had the highest AUC. CONCLUSION: The 2D and 3D myocardial strain indices correlated well with MIS by SPECT. Among them, the 2D-GLS showed the highest diagnostic value, while 3D-GRS and GCS had better diagnostic value than 2D-GRS and GCS.

Efficient and sustained IGF-1 expression in the adipose tissue-derived stem cells mediated via a lentiviral vector.

The adipose tissue-derived stem cells (ADSCs) represent a significant area of the cell therapy. Genetic modification of ADSCs may further improve their therapeutic potential. Here, we aimed to generate a lentiviral vector expressing insulin-like growth factor-I (IGF-1) and investigate the impact of IGF-1 transduction on the properties of cultured ADSCs. Isolated rat ADSCs were assessed by flow cytometric analysis. IGF-1 was cloned and inserted into the pLenO-DCE plasmid to acquire pLenO-DCE-IGF-1 plasmid. Lentivirus was enveloped with pRsv-REV, pMDlg-pRRE and pMD2G plasmids in 293T cells. The ADSCs were transfected with the vectors. And then IGF-1-induced anti-apoptosis was evaluated by annexin V-FITC. Besides, proliferation of cells was detected by MTT assay and EdU. Moreover, Akt phosphorylation was evaluated by Western blotting analysis. Stable expression of IGF-1 in ADSCs was confirmed. ADSCs were positive for CD90 and CD29, but negative for CD31, CD34 and CD45. The transduction of IGF-1 to the ADSCs caused a dramatic increase in P-Akt expression. Over-expression of IGF-1 in ADSCs could improve the paracine of IGF-1 in a time-dependent manner, but could not promote the proliferation of ADSCs. This study indicated that lentiviral vectors offered a promising mean of delivering IGF-1 to the ADSCs. Lentiviral-mediated over-expression of therapeutic IGF-1 gene in ADSCs could prolong the anti-apoptosis effect of IGF-1, which might be induced by the activation of the PI3K/Akt pathway. And our data would improve the efficacy of ADSC-based therapies.

MiR-132 inhibits expression of SIRT1 and induces pro-inflammatory processes of vascular endothelial inflammation through blockade of the SREBP-1c metabolic pathway.

PURPOSE: Inflammation participates centrally in all stages of atherosclerosis (AS), which begins with pro-inflammatory processes and inflammatory changes in the endothelium, related to lipid metabolism. MicroRNA (miRNA) inhibition of inflammation related to SIRT1 has been shown to be a promising therapeutic approach for AS. However, the mechanism of action is unknown. METHODS: We investigated whether miRNAs regulate the SIRT1 and its downstream SREBP-lipogenesis-cholesterogenesis metabolic pathway in human umbilical vein endothelial cells (HUVECs). HUVECs were transfected with miR-132 mimics and inhibitors, and then treated with or without tumor necrosis factor α (TNFα). The effects of miR-132 on pro-inflammatory processes, proliferation and apoptosis were assessed. RESULTS: We identified that the relative 3' UTR luciferase activities of SIRT1 were significantly decreased in miR-132 transfected HUVECs (0.338 ± 0.036) compared to control (P = 0.000). miR-132 inhibited SIRT1 expression of mRNA level in HUVECs (0.53 ± 0.06) (P < 0.01) as well as proteins of SIRT1. mRNA expression and protein levels of SREBP (0.45 ± 0.07), fatty acid synthase (FASN) (0.55 ± 0.09) and 3-hydroxy-3-methylglutaryl CoA reductase (HMGCR) (0.62 ± 0.08) (P < 0.01), which are downstream regulated genes, were reduced in HUVECs by miR-132. MiR-132 promoted pro-inflammatory processes and apoptosis of HUVECs induced by TNF-α, and inhibited its proliferation, viability and migration. CONCLUSIONS: SIRT1 mRNAs are direct targets of miR-132. miR-132 controls lipogenesis and cholesterogenesis in HUVECs by inhibiting SIRT1 and SREBP-1c expression and their downstream regulated genes, including FASN and HMGCR. Inhibition of SIRT1 by miR-132 was associated with lipid metabolism-dependent pro-inflammatory processes in HUVECs. The newly identified miRNA, miR-132 represents a novel targeting mechanism for AS therapy.

Effects of emodin and irbesartan on ventricular fibrosis in Goldblatt hypertensive rats.

Left ventricular (LV) fibrosis is one of the most prominent pathophysiological results of hypertension. We initiated this study to investigate the effects and mechanisms of emodin and its combination with irbesartan on LV fibrosis in Goldblatt (2K1C) hypertensive rats. Goldblatt hypertension rats were prepared by two kidney one clip (2K1C) operations and then treated with either emodin, irbesartan or their combination. As a result, the systolic blood pressure (SBP) and the left ventricular mass index (LVMI) increased significantly (P < or = 0.05) in all 2K1C rats. After drugs treatment, irbesartan and the drug combination remarkably decreased SBP, LVMI, contents of angiotensinII (AngII), hydroxyproline and collagen, the mRNA and protein expression levels of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) (P < or = 0.05). As for the emodin, LVMI, contents of hydroxyproline and collagen, and MMP-2 and TIMP-2 expression were found to decrease significantly; however, the SBP and AngII contents stayed stable within certain extent. Therefore, emodin, irbesartan or two drugs together can potentially inhibit the ventricular fibrosis in Goldblatt hypertensive rats by reducing MMP-2 and TIMP-2 expression. Furthermore, the combination of these two drugs may provide a better anti-fibrosis effect than the single application.

Leiomyosarcoma with coronary fistulae and ventricular septal perforation: A case study.

Coronary fistulae and ventricular septal perforation are very rare clinically, and even less caused by cardiac leiomyosarcoma. A case is reported that a 67-year-old female had cardiac leiomyosarcoma with progressive heart failure and coronary fistulae and ventricular septal perforation. This case was special since all ante-mortem examinations and cardiac surgery failed to detect the presence of any abnormal cardiac mass. Therefore, the malignant cardiac tumors could appear in an invasive form without mass and be one of the causes of the coronary fistulae and ventricular septal perforation.

Inhibition of protein kinase C ßII isoform ameliorates methylglyoxal advanced glycation endproduct-induced cardiomyocyte contractile dysfunction.

AIMS: Accumulation of advanced glycation endproduct (AGE) contributes to diabetic complication including diabetic cardiomyopathy although the precise underlying mechanism still remains elusive. Recent evidence depicted a pivotal role of protein kinase C (PKC) in diabetic complications. To this end, this study was designed to examine if PKCßII contributes to AGE-induced cardiomyocyte contractile and intracellular Ca(2+) aberrations. MAIN METHODS: Adult rat cardiomyocytes were incubated with methylglyoxal-AGE (MG-AGE) in the absence or presence of the PKCßII inhibitor LY333531 for 12h. Contractile and intracellular Ca(2+) properties were assessed using an IonOptix system including peak shortening (PS), maximal velocity of shortening/relengthening (±dL/dt), time-to-PS (TPS), time-to-90% relengthening (TR90), rise in intracellular Ca(2+) Fura-2 fluorescence intensity and intracellular Ca(2+) decay. Oxidative stress, O2(-) production and mitochondrial integrity were examined using TBARS, fluorescence imaging, aconitase activity and Western blotting. KEY FINDINGS: MG-AGE compromised contractile and intracellular Ca(2+) properties including reduced PS, ±dL/dt, prolonged TPS and TR90, decreased electrically stimulated rise in intracellular Ca(2+) and delayed intracellular Ca(2+) clearance, the effects of which were ablated by the PKCßII inhibitor LY333531. Inhibition of PKCßII rescued MG-AGE-induced oxidative stress, O2(-) generation, cell death, apoptosis and mitochondrial injury (reduced aconitase activity, UCP-2 and PGC-1α). In vitro studies revealed that PKCßII inhibition-induced beneficial effects were replicated by the NADPH oxidase inhibitor apocynin and were mitigated by the mitochondrial uncoupler FCCP. SIGNIFICANCE: These findings implicated the therapeutic potential of specific inhibition of PKCßII isoform in the management of AGE accumulation-induced myopathic anomalies.

[Glucometabolic abnormalities survey among outpatients without previous diabetes diagnosis and with coronary artery disease and hypertension].

OBJECTIVE: To explore the status of glucometabolic abnormalities in cardiological outpatients without previous diabetes diagnosis and with coronary artery disease (CAD) and hypertension. METHODS: Patients without previous diagnosis of diabetes but with hypertension and CAD aged 18 years or above were recruited from cardiology departments of 11 general hospitals in China. Demographic data, disease diagnosis and medical history were collected. Physical examination and questionnaire survey were performed after the random blood glucose test. Oral glucose tolerance test (OGTT) examination was made for patients with fasting blood glucose ≥ 6.1 mmol/L or postprandial random glucose ≥ 7.8 mmol/L. Adjusted prevalence rates were used in the study. RESULTS: A total of 7778 patients were included in 11 centers. After preliminary screening by fasting blood glucose and random blood glucose tests, 3861 patients were required to take OGTT, and 3019 (78.2%) patients actually took the test. 1287 out of 3019 patients screened with OGTT were diagnosed with diabetes, and the adjusted diabetes prevalence rate was 18.64% (1287/6904). The prevalence rate of diabetes was 19.87% (95/478), 9.22% (352/3819) and 14.81% (153/1033) in patients with CAD, hypertension, and CAD combined with hypertension, respectively. A total of 996 patients were diagnosed with impaired glucose tolerance (IGT) and its prevalence was 14.43% (996/6904). Of the enrolled population, 153 patients with random blood glucose lower than 7.8 mmol/L were also screened with OGTT test, 26.14% (40/153) patients met the diagnostic criteria of diabetes. CONCLUSION: A high prevalence of diabetes is found in patients without previous diagnosis of diabetes and with hypertension and CAD consulting at cardiology departments. We thus suggest to perform OGTT in this patient cohort to improve the early diagnosis of IGT and diabetes, and prevent missed detection of type 2 diabetes mellitus or IGT in cardiovascular patients with normal fasting blood glucose. Our results indicate that it was feasible to use OGTT as a screening tool for detecting diabetes in these patients and the patient compliance is satisfactory.

[Prognostic value of brain natriuretic peptide in people with viral myocarditis].

OBJECTIVE: To explore the brain natriuretic peptide (BNP) on prognostic value in patients with viral myocarditis. METHODS: A total of 48 patients with viral myocarditis and 42 healthy people were enrolled and followed up for two years. The NYHA class and LVEF were recorded and the concentration of BNP were measured. RESULTS: The concentration of BNP were higher and EF were lower in patients with viral myocarditis (P < 0.01) than contrast people. Higher levels of plasma BNP were related to higher mortality. CONCLUSION: Levels of brain natriuretic peptide measured in the plasma could be a useful biochemical marker for the myocarditis, and high concentration of BNP may correlate with poor prognosis in patients with myocarditis.

[Value of blood inflammatory markers in the diagnosis of acute appendicitis in children].

OBJECTIVE: To investigate the value of serum inflammatory markers in the diagnosis of acute appendicitis (AA) in children. METHODS: Blood samples were collected from 51 children with AA and 16 children with nonsurgical abdominal pain (NSAP) to examine white blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-α (TNF-α). RESULTS: WBC count, CRP, IL-6 and TNF-α increased significantly in children with severe AA (phlegmonous or gangrenous, and perforated appendicitis). ROC curves showed that IL-6 or TNF-α had a greater contribution than WBC count to the diagnosis of severe appendicitis. CONCLUSION: IL-6 and TNF-α can provide complementary information to assist the clinical decision of emergency operation for children with AA.