Incidence and Outcomes of Brucella Endocarditis in a High-Prevalence Area: A Single-Center Study.

OBJECTIVE: To analyze the clinical characteristics of Brucella endocarditis (BE) and observe the factors related to death to provide guidance for clinical treatment. METHODS: This study examined all patients with BE admitted to The First People's Hospital of Kashi Prefecture between January 2017 and November 2023. Clinical characteristics and follow-up outcomes were collected for analysis. RESULTS: This study revealed 774 cases of brucellosis and 14 cases of BE, with an overall incidence rate of 1.88%. Most of the patients were male (71.43%) and lived in areas where brucellosis is common. Patients ranged in age from 26 to 68 years. Common symptoms reported among patients included chest tightness and fatigue, and a significant portion also presented with congestive heart failure. Most patients exhibited normal white blood cell counts (WBC) but had elevated levels of C-reactive protein (CRP). Transthoracic ultrasound (TTE) revealed cardiac valve vegetation in all patients, along with positive blood cultures. Six patients (42.86%) completed heart surgery, and ten (71.43%) completed anti-infection treatment. Six patients died, five of whom did not undergo surgery. The other patient with Marfan syndrome died after surgery. Sex, WBC count, neutrophil (NEUT) and total bilirubin (TBIL) were significant factors associated with regression in BE patients (P < 0.05) according to univariate analysis. CONCLUSIONS: Patients with BE in Kashi have a severe clinical presentation at diagnosis, but early detection with improved cardiac ultrasound and aggressive treatment can improve the prognosis.

Type 1 diabetes, its complications, and non-ischemic cardiomyopathy: a mendelian randomization study of European ancestry.

BACKGROUND: Type 1 diabetes (T1D) is a significant risk factor for a range of cardiovascular diseases. Nonetheless, the causal relationship between T1D and non-ischemic cardiomyopathy (NICM) remains to be elucidated. Furthermore, the mechanisms responsible for the progression from T1D to NICM have not been definitively characterized. OBJECTIVE: The aim of this study was to conduct a Mendelian randomization (MR) study to investigate the causal effects of T1D and its complications on the development of NICM. Additionally, this study aimed to conduct a mediation analysis to identify potential mediators within this correlation. METHODS: Genetic variants were used as instrumental variables for T1D. The summary data for T1D were obtained from two genome-wide association study datasets. The summary data for T1D with complications and NICM were obtained from the Finnish database. Two-sample MR, multivariable MR and mediation MR were conducted in this study. RESULTS: The study revealed a causal association between T1D, T1D with complications, and NICM (with odds ratios of 1.02, 95% CI 1.01-1.04, p = 1.17e-04 and 1.03, 95% CI 1.01-1.05, p = 3.15e-3). Even after adjusting for confounding factors such as body mass index and hypertension, T1D remained statistically significant (with odds ratio of 1.02, 95% CI 1.01-1.04, p = 1.35e-4). Mediation analysis indicated that monokine induced by gamma interferon may play a mediating role in the pathogenesis of T1D-NICM (mediation effect indicated by odds ratio of 1.005, 95% CI 1.001-1.01, p = 4.9e-2). CONCLUSION: The study demonstrates a causal relationship between T1D, its complications, and NICM. Additionally, monokine induced by gamma interferon may act as a potential mediator in the pathogenesis of T1D-NICM.

Differential diagnosis between dilated cardiomyopathy and ischemic cardiomyopathy based on variational mode decomposition and high order spectra analysis.

The clinical manifestations of ischemic cardiomyopathy (ICM) bear resemblance to dilated cardiomyopathy (DCM). The definitive diagnosis of DCM necessitates the identification of invasive, costly, and contraindicated coronary angiography. Many diagnostic studies of cardiovascular disease have tried modal decomposition based on electrocardiogram (ECG) signals. However, these studies ignored the connection between modes and other fields, thus limiting the interpretability of modes to ECG signals and the classification performance of models. This study proposes a classification algorithm based on variational mode decomposition (VMD) and high order spectra, which decomposes the preprocessed ECG signal and extracts its first five modes obtained through VMD. After that, these modes are estimated for their corresponding bispectrums, and the feature vector is composed of fifteen features including bispectral, frequency, and nonlinear features based on this. Finally, a dataset containing 75 subjects (38 DCM, 37 ICM) is classified and compared using random forest (RF), decision tree, support vector machine, and K-nearest neighbor. The results show that, in comparison to previous approaches, the technique proposed provides a better categorization for DCM and ICM of ECG signals, which delivers 98.21% classification accuracy, 98.22% sensitivity, and 98.19% specificity. And mode 3 always has the best performance among single mode. The proposed computerized framework significantly improves automatic diagnostic performance, which can help relieve the working pressure on doctors, possible economic burden and health threaten.

Acute left heart failure caused by Takayasu arteritis: a case report and literature review.

Takayasu arteritis is a rare disease. Coronary involvement may appear in patients with Takayasu arteritis. With delayed diagnosis and the difficulty of treatment, Takayasu arteritis patients complicated with coronary abnormalities usually have poor prognosis. We present a rare case of acute left heart failure caused by total occlusion of the left main coronary artery due to Takayasu arteritis. A 30-year-old Chinese woman presented at our hospital with recurrent chest tightness accompanied by dyspnoea. A series of modern imaging methods were used for diagnosis and evaluation of Takayasu arteritis, including invasive angiography, CT angiography, and vascular ultrasound. The patient received drugs therapy including glucocorticoids, immunosuppressants, and cardiovascular drugs, without a reperfusion therapy. Cardiac events, inflammatory marks, and cardiac function were observed during 2-year follow-up period. In this paper, we briefly disscuss the diagnosis and treatment for young women with cardiac complication caused by Takayasu arteritis.

Impact of HbA1c variability on subclinical left ventricular remodeling and dysfunction in patients with type 2 diabetes mellitus.

BACKGROUND: Glycemic instability confers a risk of poor prognosis in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate whether HbA1c variability provided additional value over mean HbA1c for predicting subclinical left ventricular remodeling and dysfunction in T2DM patients. METHODS: A total of 466 T2DM patients with normal cardiac structure and function were recruited and prospectively followed up for a median of 4.7 y. HbA1c was measured quarterly. The intrapersonal mean and standard deviation (SD) of HbA1c measurements were calculated, and SD-HbA1c was considered as a measure of HbA1c variability. All participants underwent transthoracic echocardiography at baseline and after follow-up. RESULTS: In multivariable regression analyses, SD-HbA1c was independently associated with annualized changes in left ventricular end diastolic diameter, interventricular septum, left ventricular posterior wall, left ventricular mass index, left ventricular ejection fraction, E/e' ratio, and E/A ratio (P < 0.001). Subgroup analysis based on mean HbA1c levels (<7.0%, 7.0-7.5%, and ≥7.5%) further confirmed that SD-HbA1c was associated with most of the above parameters regardless of mean HbA1c levels. CONCLUSION: This study indicates that HbA1c variability adds to the mean value in predicting subclinical left ventricular remodeling and dysfunction in T2DM patients.

Trimetazidine inhibits cardiac fibrosis by reducing reactive oxygen species and downregulating connective tissue growth factor in streptozotocin-induced diabetic rats.

Diabetes may affect myocardial fibrosis through oxidative stress. Trimetazidine (TMZ) is an anti-anginal agent. The present study aimed to determine the modulatory effect of TMZ on reactive oxygen species (ROS) and connective tissue growth factor (CTGF) expression and to evaluate the potential of TMZ to improve diastolic function in streptozotocin (STZ)-induced diabetic rats. After treating STZ-induced diabetic rats with TMZ for 16 weeks, a decrease in malondialdehyde levels, cardiac collagen volume fraction, left ventricular (LV) end-diastolic pressure and protein expression of collagen-I (Col I), Col III and CTGF compared with those in diabetic control rats was observed. In vitro, TMZ inhibited Col I, Col III and CTGF protein expression in cardiac fibroblasts treated with high glucose and decreased intracellular ROS generation and hydroxyproline content in the cell culture medium of cardiac fibroblasts. TMZ markedly improved cardiac fibrosis and diastolic function in diabetic rats. This effect was associated with a reduction in ROS production and CTGF expression in cardiac fibroblasts. The present study suggests that TMZ may be beneficial for protecting the hearts of diabetic patients.

Immunogenicity and Safety of a Chemically Synthesized Divalent Group A Streptococcal Vaccine.

BACKGROUND: Group A streptococcus (GAS) infections and poststreptococcal sequelae remain a health problem worldwide, which necessitates searching for an effective vaccine, while no licensed GAS vaccine is available. We have developed a divalent peptide vaccine composed of 84 amino acids to cover the main GAS serotypes (M1 and M12 streptococci) in China, and herein, we aimed to evaluate immunogenicity and safety of this vaccine. METHODS: Mice were immunized with the vaccine. ELISA, indirect bactericidal test, and immunofluorescent assay were used to study immunogenicity. GAS challenge assay was used to test the protective effect. Safety was tested by histopathological analysis. RESULTS: Immunized group mice (n=16) developed higher titer antibody after immunization than nonimmunized group mice (n=16) did. This antibody can deposit on the surface of GAS and promote killing of GAS, resulting in 93.1% decrease of M1 GAS and 89.5% of M12 GAS. When challenged with M1 and M12 streptococci, immunized group mice had a higher survival rate (87.5% and 75%) than nonimmunized group mice (37.5% and 25%). No autoimmune reactions were detected on organs of mice. CONCLUSION: The results suggest that this vaccine shows fair immunogenicity and safety, which will lead our research on GAS vaccine into clinical trial.

The association between plasma homocysteine and ambulatory blood pressure variability in patients with untreated hypertension.

BACKGROUND: Both homocysteine (Hcy) and blood pressure variability (BPV) are independent predictors of stroke, however, their relationship is rarely evaluated before. This study aimed to investigate the association Hcy and ambulatory BPV in subjects with untreated primary hypertension. METHODS: A total of 252 eligible patients were recruited. Plasma Hcy was measured and 24-h ambulatory blood pressure monitoring was performed for each subject. The systolic and diastolic BPV values were calculated as the SD of individual blood pressure values during 24h, daytime and nighttime, and then stratified by the tertiles of Hcy concentration (T1 to T3). Univariate and multivariate linear regression models were used to assess the relationships between Hcy tertiles and BPV variables. RESULTS: The mean values of Hcy from T1 to T3 were 7.51±1.21µmol/l, 11.09±1.07µmol/l and 19.14±6.26µmol/l, respectively. Systolic and diastolic mean blood pressures were similar among subjects with different Hcy tertiles. However, both systolic and diastolic BPV variables, no matter in 24-h, daytime or nighttime, were increasing significantly along with the rises in Hcy tertiles (all p<0.05 for linear trends analysis). Multivariate linear regression analysis indicated that Hcy tertiles were significantly associated with BPV variables, independently of mean blood pressures other confounding factors. In subgroup analysis, the associations between Hcy tertiles and BPV variables were enhanced by the increased risk stratification of hypertension. CONCLUSIONS: Plasma Hcy was positively and independently associated with ambulatory BPV in patients with untreated hypertension.

The prognostic value of exercise-induced ventricular arrhythmias in patients with and without coronary artery disease: A meta-analysis.

BACKGROUND: Significance of exercise-induced ventricular arrhythmias (EIVAs) is controversial. This meta-analysis aimed to determine the prognostic value of EIVAs in patients with and without coronary artery disease (CAD). METHODS: Relevant studies were searched on Pubmed though December, 2015. Pooled odds ratio (OR) of endpoints (all-cause death, cardiac death or cardiac events) for all included studies was calculated at first to explore the significance of EVIAs in unselected population. Then, sensitivity analysis based on CAD status of population was performed to determine ORs of endpoints in CAD population, non-CAD population and mixed population, respectively. RESULTS: A total of 14 studies examining 23,002 patients were included, with 5 studies involved CAD population, 4 involved non-CAD population, and 5 involved mixed population (%CAD ranged from 51.2% to 76.8%). EIVAs in unselected population were associated with a pooled OR of 1.626 (95%CI 1.334 to 1.983, p<0.001) of endpoints when compared with those without EIVAs. Sensitivity analysis further indicated that pooled ORs of endpoints were 1.395 (95%CI 1.061 to 1.833, p=0.017) in CAD population, 1.933 (95%CI 1.567 to 2.384, p<0.001) in non-CAD population, and 1.402 (95%CI 1.198 to 1.640, p<0.001) in mixed population. Heterogeneous among studies was identified. Meta-regression analysis found that study quality, mean follow-up period, percentage of lost, percentage of diabetes were associated with ORs of endpoints. CONCLUSIONS: EIVAs were associated with increased risk of worse outcomes, no matter the patients had CAD or not. However, more studies are required to confirm this finding due to the variation of current evidences.

Preprocedure and Postprocedure Predictive Values of Serum ß2-Microglobulin for Contrast-Induced Nephropathy in Patients Undergoing Coronary Computed Tomography Angiography: A Comparison With Creatinine-Based Parameters and Cystatin C.

OBJECTIVE: This study aimed to investigate the values of serum ß2-microglobulin to predict contrast-induced nephropathy (CIN) before and early after coronary computed tomography angiography (CCTA), comparing with creatinine-based parameters and cystatin C. METHODS: A total of 424 patients were enrolled. Serum ß2-microglobulin, cystatin C, and creatinine were measured at 0, 24, and 48 hours of CCTA. Contrast-induced nephropathy was defined as an elevation of serum creatinine level by 25% or higher or 0.5 mg/dL or greater from baseline within 48 hours. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease study equation. Receiver operating characteristic curves and multivariate logistic regression analysis were used to detect the efficiency of biomarkers in predicting CIN. RESULTS: Fifty-two subjects (12.26%) developed CIN. Before CCTA, CIN was predicted by both baseline ß2-microglobulin (area under the receiver operating characteristic curve [AUC], 0.791; P < 0.001) and cystatin C (AUC, 0.781; P < 0.001), whereas creatinine and eGFR were not predictive. After CCTA, CIN was predicted by both the absolute post-CCTA levels of ß2-microglobulin, cystatin C, creatinine, and eGFR (AUC, 0.842 vs 0.961 vs 0.691 vs 0.688 at 24 hours, P < 0.001; and 0.937 vs 1.000 vs 0.908 vs 0.898 at 48 hours, P < 0.001) and their relative changes (Δ) to baseline (AUC, 0.677 vs 0.846 vs 0.850 vs 0.844 at 24 hours, P < 0.001; and 0.731 vs 0.968 vs 0.984 vs 0.966 at 48 hours, P < 0.001). Multivariate regression analysis confirmed that baseline ß2-microglobulin (odds ratio, 2.137; 95% confidence interval, 1.805-3.109; P < 0.001) and cystatin C (odds ratio, 1.873; 95% confidence interval, 1.667-2.341; P = 0.003) were independent predictors for CIN. CONCLUSIONS: Serum ß2-microglobulin, with values superior to creatinine-based parameters and similar with cystatin C, was a useful biomarker for the prediction of CIN at pre-CCTA and early post-CCTA.

A head-to-head comparison of homocysteine and cystatin C as pre-procedure predictors for contrast-induced nephropathy in patients undergoing coronary computed tomography angiography.

BACKGROUND: Homocysteine is a potential predictor for contrast-induced nephropathy (CIN). We aimed to compare homocysteine with cystatin C as pre-procedure predictors for CIN in patients undergoing coronary computed tomography angiography (CCTA). METHODS: A total of 580 consecutive patients were enrolled. Concentrations of plasma homocysteine and serum cystatin C were measured before CCTA. CIN is defined as an elevation of creatinine by ≥ 25% or ≥ 0.5mg/dl from baseline within 48h. Receiver operating characteristic curves, Pearson correlation coefficients and logistic regression analysis were used to evaluate the efficiency of potential predictors. RESULTS: Fifty-seven (9.83%) patients developed CIN. Concentrations of homocysteine (19.35 ± 4.32 µmol/l vs. 13.42 ± 3.96 µmol/l, p<0.001) and cystatin C (1.20 ± 0.21 mg/dl vs. 0.99 ± 0.15 mg/dl, p<0.001) increased significantly in CIN subjects. CIN was predicted by homocysteine (AUC 0.829, p<0.001) and cystatin C (AUC 0.774, p<0.001), while creatinine was not predictive. Both homocysteine and cystatin C had positive correlation with ΔCreatinine48h-0 (p<0.001) and negative correlation with ΔeGFR48h-0 (p<0.001). Regression analysis confirmed that increased baseline homocysteine [OR: 1.262 (1.123, 2.554), p<0.001] and cystatin C [OR: 1.565 (1.380, 1.775), p<0.001] were independent predictors for CIN. CONCLUSIONS: Homocysteine, with similar predictive value compared to cystatin C, was an independent biomarker for predicting CIN before CCTA examination.