Atorvastatin Treatment for Atrial Fibrillation Reduces Serum High-Sensitivity C-Reactive Protein Levels.

We investigated whether serum hs-CRP levels predict the efficacy of atrial fibrillation (AF) treated with atorvastatin. Bibliographic databases were exhaustively searched for studies relevant to the research topic. Newcastle-Ottawa Scale (NOS) criteria, combined with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS), were applied for study quality assessment. Our meta-analysis identified seven cohort studies (2006~2013), providing information on the change in serum hs-CRP levels in AF patients receiving atorvastatin therapy. After atorvastatin treatment, hs-CRP level in AF patients decreased significantly (SMD = 1.02, 95% CI: 0.58-1.47, P < 0.001). Subgroup analysis by country and hs-CRP detection methods suggested a negative relationship between atorvastatin treatment and hs-CRP levels among Chinese AF patients (SMD = 1.34, 95% CI: 1.00-1.69, P < 0.001) and by using ELISA method (SMD = 1.11, 95% CI: 0.51-1.71, P < 0.001), but not among Turkish population and using INA method (all P > 0.05). Egger's test showed no publication bias (P = 0.450). hs-CRP was clearly lowered in AF patients treated with atorvastatin, which may be helpful in the choice of statin agents for AF treatment. However, longer follow-ups are necessary to assess the clinical value of lowering hs-CRP in the clinical setting of AF treatment outcomes.

Effect of Atorvastatin on Serum Levels of Total Cholesterol and High-Sensitivity C-reactive Protein in High-Risk Patients with Atrial Fibrillation in Asia.

PURPOSE: The aim of this meta-analysis was to investigate the effects of atorvastatin on serum levels of high-sensitivity C-reactive protein (hs-CRP) and total cholesterol in atrial fibrillation (AF) patients in Asia. METHODS: By searching English and Chinese language-based electronic databases (ie, PubMed, EBSCO, Ovid, SpringerLink, Wiley, Web of Science, Wanfang database, China National Knowledge Infrastructure, and VIP database), we identified 13 studies relevant to our topic of interest. Data were collected from the 13 studies and analyzed with Comprehensive Meta-Analysis software (version 2.0, Biostat Inc., Englewood, New Jersey). FINDINGS: Initially, our database searches retrieved 356 studies (45 in English, 311 in Chinese). Thirteen studies were selected for the meta-analysis following stringent criteria. The data included 1239 patients with AF, of whom 634 were treated with atorvastatin and included in the treatment group, and 605 patients were treated with conventional treatment and included in the control group. The results of our meta-analysis suggested that the serum levels of hs-CRP (mg/L) and total cholesterol (mmol/L) in the treatment group were significantly lower than those of the control group (hs-CRP: standardized mean difference = 0.962; 95% CI, 0.629-1.295, P < 0.001; total cholesterol: standardized mean difference = 1.400; 95% CI, 0.653-2.146, P < 0.001). IMPLICATIONS: The findings of this study suggest that atorvastatin may be very effective in decreasing serum levels of hs-CRP and total cholesterol to prevent cardiovascular events.

A computer-aided diagnostic algorithm improves the accuracy of transesophageal echocardiography for left atrial thrombi: a single-center prospective study.

OBJECTIVES: We investigated whether transesophageal echocardiography (TEE) assisted with a computer-aided diagnostic (CAD) algorithm was superior to TEE in diagnosing left atrial (LA)/left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) in a single prospective study. METHODS: Transesophageal echocardiography was performed in patients with AF, and images were reconstructed. Gray level co-occurrence matrix-based features were calculated and then classified using an artificial neural network. The original data and processed images by the CAD system were studied by 5 radiologists independently in a blind manner. The diagnostic performance of each radiologist was evaluated. RESULTS: One hundred thirty patients with AF were investigated. Thirty-one patients (23.9%) had a diagnosis of LA/LAA thrombi. The mean sensitivity ± SD of TEE for LA/LAA thrombi was 0.933 ± 0.027, which was noticeably improved by CAD (0.955 ± 0.021; P < .05). The specificity of TEE was 0.811 ± 0.055, which was markedly lower than that by TEE plus CAD (0.970 ± 0.009; P < .05). The positive predictive value of TEE was low (0.613 ± 0.073) compared to that of TEE plus CAD (0.908 ± 0.027; P < .001), whereas the negative predictive values were comparable for TEE, CAD, and TEE plus CAD. Diagnosis of an LA/LAA thrombus by TEE plus CAD had a higher accuracy rate (0.966 ± 0.011) than that by TEE (0.840 ± 0.047; P < .01). The mean area under the receiver operating characteristic curve (Az) for TEE was 0.834 ± 0.009 (95% confidence interval [CI], 0.815-0.852), which was markedly lower than the Az for TEE plus CAD (0.932 ± 0.005; 95% CI, 0.921-0.943). The use of CAD significantly improved the Az values for all 5 radiologists (P < .001). CONCLUSIONS: The CAD algorithm significantly improves the diagnostic accuracy of TEE for LA/LAA thrombi in patients with AF.

Effect of pre-transplantation hemoglobin concentration on prognosis of renal transplant recipients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>For the renal transplant recipients, anemia is one of the common complications and becomes a major medical issue before transplantation. Haemoglobin (Hb) is used as a prognostic indicator, although the optimal pre-transplantation Hb concentration associated with positive prognosis is still controversial. The aim of this study was to detect the optimal Hb concentration on predicting the graft survival and function.</p><p><b>METHODS</b>A retrospective cohort study was conducted by reviewing the medical records of the patients who received renal transplantations at our center from January 2004 to June 2008. Patients were divided into two groups: high Hb group (≥ 100 g/L, n = 79) and low Hb group (< 100 g/L, n = 63). There was no significant difference between the two groups regarding sex, age, blood type and tissue types. Renal function among the two groups was measured and compared. Panel reacting antigens (PRA) of all the recipients were negative. The effect of preoperative hemoglobin concentration on the postoperative renal function recovery in both groups was further analyzed.</p><p><b>RESULTS</b>A total of 14 acute rejection episodes occurred, including 5 patients in the high Hb group (7.9%) and 9 in the low Hb group (11.4%, P > 0.05). The serum creatinine level at one-year post-transplantation of the low Hb group was significantly higher than that of the high Hb group ((117.8 ± 36.3) µmol/L vs. (103.1 ± 35.5) µmol/L, P < 0.05). For one-year actuarial patient and graft survival, incidence of delayed graft function (DGF), serum creatinine concentrations at 1, 3, 6 months post-transplantation, the incidence of cytomegalovirus (CMV) infection, post-transplantation anemia (PTA) and post-transplantation diabetes mellitus (PTDM) of both groups, there were no statistically significant differences.</p><p><b>CONCLUSION</b>Pre-transplantation Hb concentration has significant effect on one-year creatinine concentration, but can not significantly affect acute rejection episodes, DGF, PTA, CMV infection and PTDM.</p>

[Relationship between plasma brain natriuretic peptide concentration and clinical prognosis in patients of acute myocardial infarction].

OBJECTIVE: To evaluate the value of brain natriuretic peptide (BNP) in estimating risk stratification in patients with acute myocardial infarction (AMI) and to determine the relationship between BNP and adverse cardiac events after AMI. METHODS: The 135 subjects were selected into the study, including 25 healthy subjects and 110 patients with a first AMI. The plasma concentrations of BNP were measured at two to four days after infarction in patients and healthy controls. Left ventricular function was evaluated by echocardiography with the parameters of left ventricular ejection function (LVEF) after 3 months. Patients were followed up at 12 months. The main outcome measures were heart failure, left remodeling, mortality and other adverse cardiac events at one year. RESULTS: Plasma BNP concentrations in patients with AMI were much higher than those in the health control people (416.7 +/- 208.0 ng/L versus 61.8 +/- 34.1 ng/L, P < 0.01). The BNP count ranged from 5 to 2500 ng/L in AMI patients. There was no association between the BNP count and mortality rate. The development of new congestive heart failure (CHF) was associated with a higher BNP count (P = 0.02). The development of any of the clinical end points (death/CHF/shock) occurred more frequently in patients with a higher BNP count (13.8% for BNP count of < 100 ng/L, 39.1% for BNP count of 100 - 200 ng/L, 43.3% for BNP count of 200 - 400 ng/L, 46.4% for BNP count of > 400 ng/L; P = 0.019). Plasma BNP concentrations remained independently associated with the development of clinical end points in multivariable model that adjusted for potential confounding variables. CONCLUSION: The results of the present study confirm that the elevated BNP count related to the risk stratification and prognosis in patients with AMI. Elevations in BNP count are associated with a higher incidence of new CHF and adverse clinical outcomes after AMI. It could serve as a strong predictor for the subsequent development of poor outcomes in AMI patients.

[Evaluation of right ventricular function by tissue Doppler echocardiography and Tei index in right ventricular myocardial infarction].

OBJECTIVE: With tissue Doppler imaging and right ventricular Tei index, right ventricular function in patients with right ventricular myocardial infarction (RVMI) was assessed. METHOD: 51 patients admitted to coronary care units and diagnosed as acute inferior myocardial infarction were further studied with the ECG criterion of ST segment elevation >or= 1mm in V(4R) to establish the diagnosis of RVMI. 23 patients were thus diagnosed as RVMI and 28 patients not. 20 healthy subjects served as controls. Clinical and echocardiography index were recorded. Peak systolic and peak early and late diastolic velocities (Sm, Em, Am) and Em/Am were acquired from the apical four-chamber view at the lateralside of tricuspid annulus, the septal side of the tricuspid annulus and the RV free mid-wall using DTI. Interval between tricuspid closing and reopening and ejection time (ET) from parasternal short-axis view were recorded by pulse-wave Doppler. RV Tei index was calculated. RESULTS: Sm and Em at the lateral side of tricuspid annulus and the RV free mid-wall reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm at the lateral (7.0 +/- 2.0) cm/s vs (8.7 +/- 1.9) cm/s and (10.6 +/- 2.1) cm/s, P < 0.01; Em at the lateral (6.3 +/- 1.9) cm/s vs (7.9 +/- 1.8) cm/s and (9.6 +/- 1.9) cm/s, P < 0.01; Sm at the RV free mid-wall (6.4 +/- 1.9) cm/s vs (8.0 +/- 1.9) cm/s and (9.4 +/- 2.0) cm/s, P < 0.05; Em at the RV free mid-wall (6.1 +/- 2.0) cm/s vs (7.6 +/- 2.0) cm/s and (9.2 +/- 2.3) cm/s, P < 0.05). RV Tei index in patients with RVMI also increased as compared with that in the other two groups (0.65 +/- 0.19 vs 0.40 +/- 0.15 and 0.26 +/- 0.10; P < 0.01). CONCLUSIONS: The evaluation of velocities at the lateral side of tricuspid annulus and the RV free mid-wall using DTI and RV Tei index provides a noninvasive and rapid method for assessing right ventricular function in patients with RVMI.