Development of an optimized risk score to predict short-term death among acute myocardial infarction patients in rural China.

BACKGROUND: Risk stratification of patients with acute myocardial infarction (AMI) is of great clinical significance. HYPOTHESIS: The present study aimed to establish an optimized risk score to predict short-term (6-month) death among rural AMI patients from China. METHODS: We enrolled 6581 AMI patients and extracted relevant data. Patients were divided chronologically into a derivation cohort (n = 5539), to establish the multivariable risk prediction model, and a validation cohort (n = 1042), to validate the risk score. RESULTS: Six variables were identified as independent predictors of short-term death and were used to establish the risk score: age, Killip class, blood glucose, creatinine, pulmonary artery systolic pressure, and percutaneous coronary intervention treatment. The area under the ROC curve (AUC) of the optimized risk score was 0.82 within the derivation cohort and 0.81 within the validation cohort. The diagnostic performance of the optimized risk score was superior to that of the GRACE risk score (AUC 0.76 and 0.75 in the derivation and validation cohorts, respectively; p < .05). CONCLUSION: These results indicate that the optimized scoring method developed here is a simple and valuable instrument to accurately predict the risk of short-term mortality in rural patients with AMI.

The potential of chrysophanol in protecting against high fat-induced cardiac injury through Nrf2-regulated anti-inflammation, anti-oxidant and anti-fibrosis in Nrf2 knockout mice.

Cardiovascular complications induced by high fat are one of the most challenging health problems presently. Oxidative stress, inflammation and fibrosis are major components included in the pathology of diabetic cardiomyopathy. Nuclear factor erythroid 2-related factor 2 (Nrf2) has been reported as an essential therapeutic target in various diseases for its induction of anti-oxidant enzymes, and other protective enzymes. Additionally, a number of Nrf2 activators showed strong anti-inflammatory properties. In the study, we calculated the Nrf2-dependent anti-oxidant, anti-inflammatory and anti-fibrosis effects of chrysophanol in high fat diet-induced diabetic heart injury. The underlying mechanisms of chrysophanol were explored using H9C2 cells in vitro. For the in vivo experiment, cardiac injury was triggered in wild type (Nrf2+/+) and Nrf2-knockout (Nrf2-/-) mice by high fat diet, and chrysophanol was administered after high fat feeding for two weeks. In Nrf2+/+ mice, but not the Nrf2-/- animals, chrysophanol ameliorated metabolic disorders, improved cardiac function, reduced pathological changes, attenuated oxidative injury, down-regulated inflammatory response and fibrosis progression through regulating different signaling pathways. Our data indicated that the anti-oxidant, anti-inflammatory and anti-fibrosis effects of chrysophanol are regulated by Nrf2 expression. Thus, we supposed that chrysophanol could be used as a safe therapeutic strategy to ameliorate cardiac injury induced by high fat diet.

NLRP4 is an essential negative regulator of fructose-induced cardiac injury in vitro and in vivo.

High fructose consumption leads to metabolic syndrome and enhances cardiovascular disease risk. However, our knowledge of the molecular mechanism underlying the cardiac disease caused by fructose feeding is still poor. Nod-like receptors (NLRs) are intracellular sensors, responding to a variety of intracellular danger signals to induce injuries. NLRP4 is a negative regulator of nuclear factor-κB (NF-κB) signaling pathway through interactions with kinase IκB kinase (IKK). Here, we illustrated that NLRP4 attenuates pro-inflammatory cytokines releasing, including Transforming growth factor (TGF-ß1), Tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-18 (IL-18) and interleukin-6 (IL-6), in fructose-treated cardiac cells by means of RT-qPCR, and western blotting analysis. In addition, NLRP4 could reduce the expression of TANK-binding kinase 1/interferon regulatory factor 3 (TBK1/IRF3), reducing inflammation response and achieving its anti-hypertrophic action. TBK1 plays critical roles in the IRF3 signaling pathway, modulating inflammation response. The inhibition of IKK/NF-κB signaling pathway by NLRP4 is confirmed by NLRP4 over-expression and knockdown. In vivo, high fructose feeding induced cardiac injury, accompanied with reduced expression of NLRP4 in heart tissue samples, indicating the possible role of NLRP4 in ameliorating heart injury. In conclusion, the findings above indicated that NLRP4 is an important mediator of cardiac remodeling in vitro and in vivo through negatively regulating TBK1/IRF3 and IKK/NF-κB signaling pathways, indicating that NLRP4 might be a promising therapeutic target against cardiac inflammation.