Clinical Significance of Arterial Stiffness and Thickness Biomarkers in Type 2 Diabetes Mellitus: An Up-To-Date Meta-Analysis.

BACKGROUND: Type 2 Diabetes mellitus (T2DM) is associated with increased risk of cardiovascular disease (CVD). Previous studies explored the association of T2DM with arterial stiffness and thickness biomarkers including the augmentation index (AIX), aortic pulse wave velocity (aPWV), brachial-ankle PWV (baPWV), carotid intima-media wall thickness (IMT) as well as blood pressure (BP), low density lipoprotein cholesterol (LDL-C); however the conclusions are either inconsistent or incomprehensive. MATERIAL AND METHODS: The average differences of each included trial were expressed as the standardized mean difference (SMD) with 95% confidence interval (CI). Analyses of carotid IMT, aPWV, baPWV and AIX Systolic BP (SBP), diastolic BP (DBP), LDL-C and HDL-C were independently performed. Furthermore, subgroup analyses by ethnicity (Caucasian or Asian) were conducted. Begg's and Egger's tests were performed for potential publication biases detection. RESULTS: A total of 14 case-control eligible studies with 1222 T2DM patients and 1094 control subjects were included. In the overall analysis, significant associations were observed between the carotid IMT, aPWV, baPWV, LDL-C, HDL-C, SBP, and DBP with T2DM (IMT: p=1.1*10-12; aPWV: p=1.1*10-7; baPWV: p=1.8*10-33; LDL-C: p=3.1*10-8; HDL-C: p=6.1*10-18; SBP: p=3.9*10-21; DBP: p=4.8*10-5). No association was detected for AIX (p=0.09). Subgroup analyses indicated that aPWV, baPWV, SBP, LDL-C, and HDL-C were associated with T2DM in both white and Asian populations (p<0.05). The significant associations of IMT, AIX and DBP with T2DM were only observed in the Asian subgroup. CONCLUSIONS: Carotid IMT, aPWV, baPWV, as well as LDL-C, HDL-C, SBP, and DBP but not AIX were useful noninvasive early markers for T2DM vascular dysfunction detection.

The prognosis and risk stratification of patients with left main coronary artery disease after percutaneous coronary intervention or coronary artery bypass grafting / 实用医学杂志

Objective To compare the incidence of MACE and predictors in patients with unprotected left main coronary artery disease (ULMCAD) after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). To establish a risk stratification to guide treatment and prognosis of patients with ULMCAD who underwent PCI. Methods The incidence of MACE in 201 patients with ULMCAD who underwent PCI or CABG was compared, retrospectively. The predictors of MACE of the two groups were obtained by logistic regression analyses. The predictors of MACE of the PCI group were assigned and stratified. The validity of the risk stratification on the prediction of MACE was verified in a new group of 126 patients with ULMCAD who underwent PCI. Results The incidence of MACE of PCI and CABG group was 16% and 11.9%, respectively. Logistic regression analyses showed that LVEF, diabetes mellitus and Syntax score were related to MACE in PCI group, while age, LVEF and renal function insufficiency were related to MACE in CABG group. The verification results showed a good predictive value of the risk stratification based on LVEF, diabetes mellitus and Syntax score on the incidence of MACE. Conclusions PCI treatment in patients with ULMCAD is feasible and has a good long-term outcome. The risk stratification in accordance with LVEF, diabetes mellitus and Syntax score has good predictive value on the incidence of MACE.

Effect of Heart Rate and Coronary Calcification on the Diagnostic Accuracy of the Dual-Source CT Coronary Angiography in Patients with Suspected Coronary Artery Disease

OBJECTIVE: To evaluate the diagnostic accuracy of a dual-source computed tomography (DSCT) coronary angiography, with a particular focus on the effect of heart rate and calcifications. MATERIALS AND METHODS:One hundred and nine patients with suspected coronary disease were divided into 2 groups according to a mean heart rate ( or = 70 bpm) and into 3 groups according to the mean Agatston calcium scores ( 400). Next, the effect of heart rate and calcification on the accuracy of coronary artery stenosis detection was analyzed by using an invasive coronary angiography as a reference standard. Coronary segments of less than 1.5 mm in diameter in an American Heart Association (AHA) 15-segment model were independently assessed. RESULTS: The mean heart rate during the scan was 71.8 bpm, whereas the mean Agatston score was 226.5. Of the 1,588 segments examined, 1,533 (97%) were assessable. A total of 17 patients had calcium scores above 400 Agatston U, whereas 50 had heart rates > or = 70 bpm. Overall the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) for significant stenoses were: 95%, 91%, 65%, and 99% (by segment), respectively and 97%, 90%, 81%, and 91% (by artery), respectively (n = 475). Heart rate showed no significant impact on lesion detection; however, vessel calcification did show a significant impact on accuracy of assessment for coronary segments. The specificity, PPV and accuracy were 96%, 80%, and 96% (by segment), respectively for an Agatston score less than 100% and 99%, 96% and 98% (by artery). For an Agatston score of greater to or equal to 400 the specificity, PPV and accuracy were reduced to 79%, 55%, and 83% (by segment), respectively and to 79%, 69%, and 85% (by artery), respectively. CONCLUSION: The DSCT provides a high rate of accuracy for the detection of significant coronary artery disease, even in patients with high heart rates and evidence of coronary calcification. However, patients with severe coronary calcification (> 400 U) remain a challenge to diagnose.

Relationship between cardiac troponin I, ongoing myocardial injury, and ventricular arrhythmia severity in patients with congestive heart failure / 介入放射学杂志

or =0.05 ng/ml (n=110) and cTnI-negative with serum cTnI

Effect of granulocyte-colony stimulating factor on the reendothelialization and intima hyperplasia of ballon-injured rat carotid artery / 中国病理生理杂志

AIM: To study the effect of mobilization of stem cells by exogenous recombinant human granulocyte-colony stimulating factor (rhG-CSF) on the repairing process of reendothelialization and neointima hyperplasy on ballon injured rat carotid arteries. METHODS: Male Wistar rats were randomly divided into rhG-CSF group and NS+injury group. The animals were injected daily with 30 ?g/kg rhG-CSF or 0.9% NaCl for 7 days, then underwent balloon angioplasty of the common carotid arteries which were harvested and processed for scanning electron microscopy (SEM), Evans blue staining, morphometric analysis of endothelialization and neointimal formation at 1 h, 3 d, 5 d, 7 d, 14 d after injury. Immunohistochemistry for proliferation cell nuclear antigen (PCNA) and RT-PCR for eNOS mRNA were also conducted for evaluating the proliferation of cells of the vessel wall and the possible mechanism of the repairing. RESULTS: SEM and Evan’s blue staining showed increased reendothelialization of the denuded vessels in rhG-CSF-treated animals compared with that NS+injury animals [(60.6?7.3)% vs (41.6?3.3)%,P

Inhibitory effect of high-dose Xuezhikang on inflammatory response induced by percutaneous coronary intervention in patients with unstable angina / 中国病理生理杂志

0.05),however,after three days of pharmacological treatment,there was significantly reduced CRP content in group A [(5.44?1.57)mg/L vs(4.04?1.54)mg/L,P

Relationship And Conflict of Interests Between Doctors And Patients in Percutaneous Coronary Intervention / 中国医学伦理学

Presently there is co-existed of over-and deficient treatment in percutaneous coronary intervention in china and the conflict of interest between doctors and patients among which mainly appeared to be financial conflict.The conflict is resulted from deviation of direction in reformation of economy policy,mismatched conditions between medical ethics and medical technique,misunderstanding between doctors and patients.In this paper we discussed the resolving methods,including enhancing healthy economy reformation,establishing harmonious relationship between doctors and patients,optimizing the utilizing of interventional technique.We also must persist in justice and public good principle.Undoubtedly to say conflict of interests between doctors and patients always exists,the way to minimize it relay on co-exertion of society,governmental control agency,doctors and patients,and this will take a long time.

Ethical Reflection on the Over-use of Percutaneous Coronary Intervention / 中国医学伦理学

The problem of over-treatment of percutaneous coronary intervention is expounded in the paper.From the prospective of ethics,several factors such as doctor,patient and even society,all of which can affect the excessive implement of percutaneous coronary intervention,are analyzed in the article.Effective counter-measures to help the development of the technique are also discussed.