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1.
Sci Rep ; 14(1): 9147, 2024 04 21.
Article in English | MEDLINE | ID: mdl-38644461

ABSTRACT

To investigate the predictive value of baseline platelet count and its short-term dynamic changes in the prognosis of patients with acute heart failure (AHF) in the intensive care unit. Patients diagnosed with AHF in the medical information mart for intensive care III and their clinical data were retrospectively filtered. Patients were divided into survivor and non-survivor groups based on their prognosis during hospitalization, and differences in baseline data between groups were compared. Logistic regression models and restricted cubic spline (RCS) plots were performed to evaluate the relationship between baseline platelet counts and in-hospital mortality. Changes and trends in platelet counts were compared between the survivor and non-survivor groups after adjusting for confounders with the generalized additive mixing model (GAMM). A total of 2930 critical patients with acute heart failure were included, of which 2720 were survivors and 210 were non-survivors. Multiple logistic regression models revealed that baseline platelet count was an independent factor in hospital mortality (OR 0.997, 95% CI 0.994-0.999, P-value = 0.018). The RCS plot demonstrated a U-shaped dose-response relationship between baseline platelet count and in-hospital mortality. GAMM analysis suggested that the platelet counts decreased and then increased in the survivor group and gradually decreased in the non-survivor group, with a gradual increase of difference between two groups. After adjusting for confounders, the mean daily increase was -6.014 (95% CI -7.076-4.953, P-value < 0.001). Baseline platelet demonstrated a U-shaped dose-response relationship with adverse outcomes in critical patients with AHF. Early elevation of platelet was correlated with higher in-hospital mortality, indicating that tracking early changes in platelet might help determine the short-term prognosis of critical patients with AHF.


Subject(s)
Heart Failure , Hospital Mortality , Humans , Heart Failure/mortality , Heart Failure/blood , Male , Female , Platelet Count , Aged , Prognosis , Retrospective Studies , Middle Aged , Acute Disease , Aged, 80 and over , Intensive Care Units
2.
J Inflamm Res ; 16: 1825-1836, 2023.
Article in English | MEDLINE | ID: mdl-37131410

ABSTRACT

Objective: The association between serum uric acid (sUA) and incident abdominal aortic calcification (AAC), and severe abdominal aortic calcification (SAAC) in the general population of the United States (US) is unclear. Therefore, this research aimed to investigate the association between sUA and the risk of AAC and SAAC. Methods: Individuals from National Health and Nutrition Examination Survey (NHANES) database were analyzed cross-sectionally between 2013 and 2014. The restricted cubic spline (RCS), multivariable logistic regression model and subgroup analysis were utilized to evaluate the correlation between sUA and incident AAC, and SAAC. In addition, generalized additive models with smooth functions were employed to survey the relationship between sUA and the degree of AAC. Results: This study included 3016 individuals from the NHANES database. According to the RCS plot, sUA levels were associated with the risk of AAC/SAAC in a U-shaped pattern in the US population. The degree of calcification decreased at first and then increased with the increase in the sUA level. Conclusion: Close monitoring and adequate control of sUA levels in the US general population may reduce the risk of AAC and SAAC.

3.
Postgrad Med ; 135(5): 511-518, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37138534

ABSTRACT

BACKGROUND: Serum uric acid (SUA) has been shown to increase all-cause mortality from cardiovascular disease. However, limited studies have examined the mediating effect of dyslipidemia, hyperglycemia, or hypertension on the association between SUA and all-cause mortality in patients with congestive heart failure (CHF). METHODS: Participants in the present investigation were 620 US adults with CHF from the NHANES database (1999-2014). The relationship between SUA and all-cause mortality was evaluated utilizing multivariable Cox proportional hazards models. Additionally, the nonlinearity between SUA and mortality was investigated utilizing Restricted Cubic Splines (RCS) and 2-piecewise Cox proportional hazards models. Finally, the mediating role of cardiometabolic factors on the relationship between SUA and all-cause mortality was investigated utilizing the mediation analysis. RESULTS: During a mean follow-up of 7.6 years, 391 (63.1%) all-cause deaths occurred. Furthermore, we found a U-shaped association between SUA and all-cause mortality. The inflection point for the RCS curve was found at a SUA level of 363 umol/L. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.998 (0.995-1.000) and 1.003 (1.002-1.005) to the left and right of the inflection point, respectively. This U-shaped association was also observed in both subgroups of sex and age. Moreover, the effect of SUA on all-cause mortality was not mediated by hypertension, hyperglycemia, or dyslipidemia (all P-values>0.05). CONCLUSION: The association between SUA level and all-cause mortality followed a U-shaped curve, and this association was not mediated by hypertension, hyperglycemia, or dyslipidemia.


Subject(s)
Cardiovascular Diseases , Heart Failure , Hyperglycemia , Hypertension , Humans , Adult , Uric Acid , Nutrition Surveys , Risk Factors , Heart Failure/epidemiology , Hypertension/epidemiology , Hyperglycemia/epidemiology
4.
Sci Rep ; 13(1): 4585, 2023 03 20.
Article in English | MEDLINE | ID: mdl-36941404

ABSTRACT

The purpose of this study was to explore the use of aspirin in conjunction with various statins for cardiovascular disease (CVD) prevention in the general population of the United States (U.S.). A total of 3778 people from the National Health and Nutrition Examination Surveys from 2011 to 2018 were included in our analysis. After adjusting for sociodemographic and common cardiovascular risk factors, we used multivariable logistic regression analysis to determine aspirin should be combined with which type of statin for better CVD preventive effects. Subgroup analyses were carried out subsequently. In comparison to the aspirin use alone, the odds ratios with 95% confidence intervals for CVD were 0.43 (0.33, 0.57), 0.69 (0.42, 1.13), 0.44 (0.31, 0.62), 0.34 (0.23, 0.50) and 0.64 (0.49, 0.84) for the combination use of aspirin and atorvastatin, lovastatin, pravastatin, rosuvastatin as well as simvastatin, respectively, in the fully-adjusted model. Aspirin combined with rosuvastatin was more effective in the prevention of individual CVD, including congestive heart failure, coronary heart disease, angina pectoris and heart attack, than aspirin combined with other statins. In conclusion, statins combined with aspirin have a clear advantage over aspirin alone in preventing CVD. In addition, when various sex, age, and fitness levels were considered, as well as with and without diabetes mellitus, the combination usage of aspirin and rosuvastatin had the greatest CVD preventive effects than aspirin coupled with other statins.


Subject(s)
Cardiovascular Diseases , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Humans , United States/epidemiology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Rosuvastatin Calcium/therapeutic use , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/chemically induced , Aspirin/therapeutic use , Simvastatin/adverse effects
5.
Int J Clin Pract ; 2023: 1621873, 2023.
Article in English | MEDLINE | ID: mdl-36815008

ABSTRACT

In the American population, the relationship between the standardized serum 25-hydroxyvitamin D (25(OH)D) concentration and the risk of abdominal aortic calcification (AAC) is unclear. The purpose of our study was to investigate the relationship between serum 25(OH)D concentration and AAC risk. Participants from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2014 were analyzed cross sectionally. An analysis of the relationship between serum 25(OH)D concentration and incident AAC and severe AAC (SAAC) was based on the restricted cubic spline (RCS) and multivariable logistic regression model. In addition, generalized additive models with smooth functions were used to evaluate the relationship between serum 25(OH)D concentration and the degree of AAC. Finally, a subgroup analysis was conducted. There were a total of 3,040 individuals in our study. The serum 25(OH)D concentration was divided into quartiles (Q1: 9.37-50.5 nmol/L; Q2: 50.6-67.2 nmol/L; Q3: 67.3-85.8 nmol/L; and Q4: 85.9-318.0 nmol/L); the lowest quartile served as the reference group (Q1). After adjusting for known confounding variables, compared with the lowest quartile (Q1) of serum 25(OH)D concentration, the odds ratios with 95% confidence intervals for AAC and SAAC across the quartiles (Q2, Q3, and Q4) were (1.042 (0.812, 1.338), 0.863 (0.668, 1.115), and 1.022 (0.787, 1.327)) and (1.48 (0.87, 2.52), 1.70 (1.01, 2.92), and 2.13 (1.19, 3.86)), respectively. As shown by the RCS plot, the serum 25(OH)D concentration was associated with the risk of AAC/SAAC in a U-shaped pattern (P for nonlinearity <0.05). In addition, the degree of AAC decreased at first and then increased as the serum 25(OH)D concentration increased. In conclusion, a U-shaped relationship existed between serum 25(OH)D concentration and the risk of AAC and SAAC. Consequently, the risk of AAC and SAAC may be mitigated with regular monitoring and vitamin D supplementation.


Subject(s)
Vitamin D Deficiency , Vitamin D , Humans , United States , Nutrition Surveys , Cross-Sectional Studies , Risk Factors
6.
Postgrad Med ; 135(1): 50-57, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36154549

ABSTRACT

OBJECTIVE: Association between neutrophil-to-lymphocyte ratio (NLR) on admission and poor prognosis in patients with acute heart failure (AHF) has been well established. However, the relationship between dynamic changes in NLR and in-hospital mortality in AHF patients has not been studied. Our purpose was to determine if an early change in NLR within the first week after AHF patients was admitted to intensive care unit (ICU) was associated with in-hospital mortality. METHODS: Data from the medical information mart for intensive care IV (the MIMIC-IV) database was analyzed. The effect of baseline NLR on in-hospital mortality in critical patients with AHF was evaluated utilizing smooth curve fitting and multivariable logistic regression analysis. Moreover, comparison of the dynamic change in NLR among survivors and non-survivors was performed using the generalized additive mixed model (GAMM). RESULTS: There were 1169 participants who took part in the present study, 986 of whom were in-hospital survivors and 183 of whom were in-hospital non-survivors. The smooth curve fitting revealed a positive relationship between baseline NLR and in-hospital mortality, and multivariable logistic regression analysis indicated that baseline NLR was an independent risk factor for in-hospital mortality (OR 1.04, 95% CI 1.02,1.07, P-value = 0.001). After adjusting for confounders, GAMM showed that the difference in NLR between survivors and non-survivors grew gradually during the first week after ICU admission, and the difference grew by an average of 0.51 per day (ß = 0.51, 95% CI 0.45-0.56, P-value <0.001). CONCLUSIONS: Baseline NLR was associated with poor prognosis in critical patients with AHF. Early rises in NLR were linked to higher in-hospital mortality, which suggests that keeping track of how NLR early changes might help identify short-term prognosis of critical patients with AHF.


Subject(s)
Lymphocytes , Neutrophils , Humans , Hospital Mortality , Retrospective Studies , Prognosis
7.
Aging (Albany NY) ; 13(16): 20569-20584, 2021 08 30.
Article in English | MEDLINE | ID: mdl-34460437

ABSTRACT

BACKGROUND: Myocardial ischemia/reperfusion (I/R) injury is common during the treatment of cardiovascular diseases. Neuronal PAS Domain Protein 2 (NPAS2) is one of the core genes that control the rhythm of the biological clock. NPAS2 also regulates the biological rhythm. RESULTS: The rat I/R model showed that the expression of NPAS2 decreased with the increase of reperfusion time. Overexpressing NPAS2 adenovirus (ad-NPAS2) was injected into IR rat which demonstrated that ad-NPAS2 ameliorated rats I/R injury. A hypoxia/reoxygenation (H/R) model in rat cardiomyocytes showed that ad-NPAS2 inhibited cardiomyocyte apoptosis. Co-Immunoprecipitation results showed that there is an interaction between NPAS2 and Cry2. Knockdown of Cry2 aggravated the cardiomyocyte apoptosis induced by H/R. Additionally, NPAS2 directly act on the promoter region of CX3CL1. Knockdown of CX3CL1 reverse the protective effect of ad-NPAS2 on rat myocardial ischemia-reperfusion injury and H/R-induced cardiomyocyte apoptosis. CX3CL1 also regulates autophagy through the downstream AKT/mTOR pathway. CONCLUSIONS: research demonstrated that overexpression of NPAS2 interacts with Cry2 and promotes the transcriptional activity of CX3CL1. Moreover, overexpression of NPAS2 regulates the downstream AKT/mTOR pathway to inhibit autophagy in order to improve rat cardiac I/R injury.


Subject(s)
Autophagy , Chemokine CX3CL1/metabolism , Circadian Clocks/genetics , Circadian Rhythm Signaling Peptides and Proteins/metabolism , Myocardial Infarction/metabolism , Myocardial Reperfusion Injury/metabolism , Animals , Apoptosis , Circadian Rhythm Signaling Peptides and Proteins/genetics , Disease Models, Animal , Hypoxia , Male , Myocardial Infarction/genetics , Myocardial Reperfusion Injury/genetics , Myocardium/metabolism , Myocardium/pathology , Myocytes, Cardiac , Promoter Regions, Genetic , Proto-Oncogene Proteins c-akt/metabolism , Rats, Sprague-Dawley , Signal Transduction , TOR Serine-Threonine Kinases/metabolism
8.
BMC Cardiovasc Disord ; 20(1): 423, 2020 09 22.
Article in English | MEDLINE | ID: mdl-32962641

ABSTRACT

BACKGROUND: Familial dilated cardiomyopathy (FDCM) is most commonly inherited as an autosomal dominant trait. The Lamin A/C (LMNA) gene variants have been identified to be associated with DCM, conductive system disorders, type 2 Emery-Dreifuss muscular dystrophy and several other disorders. Here, we reported a novel variant in the LMNA gene that might be related to FDCM. CASE PRESENTATION: A 30-year-old young man was hospitalized for chest tightness, extreme fatigue, palpitation and impaired activity tolerance. He had clinical characteristics including cardiac dilatation, atrial tachyarrhythmia, severe conductive system disorders, and dyskinesia of both upper limbs and the neck. Genetic sequence analysis indicated that the patient carried a novel c.1325 T>C heterozygous LMNA gene variant. Catheter ablation and cardiac resynchronization therapy with pacing function (CRT-P) were performed to treat the arrhythmia. CONCLUSION: The variant c.1325 T>C is a novel variant in the LMNA gene that has not been previously reported. Young patients with DCM, conductive system disorders and skeletal myopathy should be alert to the possibility of LMNA gene variant. Cardiac resynchronization therapy (CRT) may be a reasonable choice for patient carrying a LMNA gene variant with third-degree atrioventricular block even if the left ventricular ejection fraction is preserved in order to prevent the deterioration of cardiac function caused by right ventricular pacing dependency.


Subject(s)
Arrhythmias, Cardiac/genetics , Cardiomyopathy, Dilated/genetics , Lamin Type A/genetics , Mutation, Missense , Adult , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Cardiac Resynchronization Therapy , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnostic imaging , Catheter Ablation , Genetic Predisposition to Disease , Heterozygote , Humans , Male , Phenotype
9.
J Cardiovasc Electrophysiol ; 31(6): 1539-1543, 2020 06.
Article in English | MEDLINE | ID: mdl-32337777

ABSTRACT

Permanent left bundle branch area pacing (LBBP) is a promising physiological pacing technique that has emerged in recent years. However, LBBP is almost exclusively clinically applied in adult patients. The feasibility and safety of the use of LBBP in children have not been well-assessed. Here, we report the case of a 6-year-old child with a third-degree atrioventricular block after surgical aortic valve replacement who successfully received a permanent LBBP.


Subject(s)
Atrioventricular Block/therapy , Bundle of His/physiopathology , Cardiac Pacing, Artificial , Action Potentials , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/physiopathology , Bicuspid Aortic Valve Disease/surgery , Child , Heart Rate , Heart Valve Prosthesis Implantation/adverse effects , Humans , Treatment Outcome
10.
Pacing Clin Electrophysiol ; 42(7): 821-827, 2019 07.
Article in English | MEDLINE | ID: mdl-31004502

ABSTRACT

BACKGROUND: Syncope is a perplexing challenge that often receives thorough evaluation, yet the diagnosis remains unclear. Usually, the emergency department is the first point at which patients present with syncope. However, diverse medical factors, including low diagnostic rates and inconsistent management by doctors, add to healthcare costs and delay diagnosis for syncope patients. METHODS: Patients who had been to the emergency department at least once but were not given a clear diagnosis of syncope were recruited into our study at the time they visited syncope clinic staffed by a multidisciplinary team. Complete medical histories and clinical examinations were conducted by both experienced cardiologists and neurologists. If patients were not given a conclusive diagnosis at the syncope clinic on the basis of outpatient examinations, they were admitted for further evaluation. RESULTS: A total of 209 consecutive patients claiming "syncope" visited the syncope clinic, yet only 167 patients were formally diagnosed with syncope. For these 167 patients, the mean age was 55.93 ± 17.40 years old, and 41.3% were male. The proportions of cardiac syncope, reflex syncope, orthostatic hypotension (OH), and syncope of uncertain etiology were 19.8%, 64.1%, 7.8%, and 8.4%, respectively. The diagnostic rate was 91.6%, and the hospitalization rate was 23.4%. Patients with reflex syncope and OH were younger than patients with cardiac syncope. Cardiac syncope tends to occur more frequently in males, while reflex syncope is more likely in females. CONCLUSIONS: The cooperation of professional cardiologists and neurologists will play an important role in improving diagnostic rates, lowering admission rates, and reducing medical costs.


Subject(s)
Patient Care Team , Syncope/diagnosis , Cardiologists , Diagnosis, Differential , Emergency Service, Hospital , Female , Humans , Male , Medical History Taking , Middle Aged , Neurologists , Physical Examination
11.
Cell Physiol Biochem ; 46(1): 9-22, 2018.
Article in English | MEDLINE | ID: mdl-29566363

ABSTRACT

BACKGROUND/AIMS: Increased endoplasmic reticulum (ER) stress contributes to development of cardiorenal syndrome (CRS), and Silent Information Regulator 1 (SIRT1), a class III histone deacetylase, may have protective effects on heart and renal disease, by reducing ER stress. We aimed to determine if SIRT1 alleviates CRS through ER stress reduction. METHODS: Wild type mice (n=37), mice with cardiac-specific SIRT1 knockout (n=29), or overexpression (n=29), and corresponding controls, were randomized into four groups: sham MI (myocardial infarction) +sham STNx (subtotal nephrectomy); MI+sham STNx; sham MI+STNx; and MI+STNx. To establish the CRS model, subtotal nephrectomy (5/6 nephrectomy, SNTx) and myocardial infarction (MI) (induced by ligation of the left anterior descending (LAD) coronary artery) were performed successively to establish CRS model. At week 8, the mice were sacrificed after sequential echocardiographic and hemodynamic studies, and then pathology and Western-blot analysis were performed. RESULTS: Neither MI nor STNx alone significantly influenced the other healthy organ. However, in MI groups, STNx led to more severe cardiac structural and functional deterioration, with increased remodeling, increased BNP levels, and decreased EF, Max +dp/dt, and Max -dp/dt values than in sham MI +STNx groups. Conversely, in STNx groups, MI led to renal structural and functional deterioration, with more severe morphologic changes, augmented desmin and decreased nephrin expression, and increased BUN, SCr and UCAR levels. In MI+STNx groups, SIRT1 knockout led to more severe cardiac structural and functional deterioration, with higher Masson-staining score and BNP levels, and lower EF, FS, Max +dp/dt, and Max -dp/dt values; while SIRT1 overexpression had the opposite attenuating effects. In kidney, SIRT1 knockout resulted in greater structural and functional deterioration, as evidenced by more severe morphologic changes, higher levels of UACR, BUN and SCr, and increased desmin and TGF-ß expression, while SIRT1 overexpression resulted in less severe morphologic changes and increased nephrin expression without significant influence on BUN or SCr levels. The SIRT1 knockout but not overexpression resulted in increased myocardial expression of CHOP and GRP78. Cardiac-specific SIRT1 knockout or overexpression resulted in increased or decreased renal expression of CHOP, Bax, and p53 respectively. CONCLUSIONS: Myocardial SIRT1 activation appears protective to both heart and kidney in CRS models, probably through modulation of ER stress.


Subject(s)
Cardio-Renal Syndrome/pathology , Endoplasmic Reticulum Stress/physiology , Heart/physiopathology , Kidney/pathology , Sirtuin 1/metabolism , Animals , Cardio-Renal Syndrome/etiology , Cardio-Renal Syndrome/metabolism , Creatinine/blood , Desmin/metabolism , Disease Models, Animal , Endoplasmic Reticulum Chaperone BiP , Kidney/metabolism , Male , Membrane Proteins/metabolism , Mice , Mice, Inbred C57BL , Mice, Knockout , Myocardial Infarction/complications , Myocardial Infarction/pathology , Myocardium/pathology , Nephrectomy , Sirtuin 1/deficiency , Sirtuin 1/genetics , Transcription Factor CHOP/metabolism , Transforming Growth Factor beta/metabolism
12.
Braz J Cardiovasc Surg ; 32(2): 96-103, 2017.
Article in English | MEDLINE | ID: mdl-28492790

ABSTRACT

INTRODUCTION:: The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization. Infusion of low dose recombinant human brain natriuretic peptide (rhBNP) at the time of AMI is well tolerated and could improve cardiac function. OBJECTIVE:: The objective of this study was to evaluate the hemodynamic effects of rhBNP in AMI patients revascularized by emergency percutaneous coronary intervention (PCI) who developed cardiogenic shock. METHODS:: A total of 48 patients with acute ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and whose hemodynamic status was improved following emergency PCI were enrolled. Patients were randomly assigned to rhBNP (n=25) and control (n=23) groups. In addition to standard therapy, study group individuals received rhBNP by continuous infusion at 0.005 µg kg-1 min-1 for 72 hours. RESULTS:: Baseline characteristics, medications, and peak of cardiac troponin I (cTnI) were similar between both groups. rhBNP treatment resulted in consistently improved pulmonary capillary wedge pressure (PCWP) compared to the control group. Respectively, 7 and 9 patients died in experimental and control groups. No drug-related serious adverse events occurred in either group. CONCLUSION:: When added to standard care in stable patients with cardiogenic shock complicating anterior STEMI, low dose rhBNP improves PCWP and is well tolerated.


Subject(s)
Anterior Wall Myocardial Infarction/drug therapy , Natriuretic Peptide, Brain/administration & dosage , Percutaneous Coronary Intervention/mortality , ST Elevation Myocardial Infarction/drug therapy , Aged , Analysis of Variance , Anterior Wall Myocardial Infarction/complications , Anterior Wall Myocardial Infarction/mortality , Blood Pressure/drug effects , Female , Heart Rate/drug effects , Humans , Intra-Aortic Balloon Pumping/methods , Male , Middle Aged , Natriuretic Peptide, Brain/pharmacology , Natriuretic Peptide, Brain/therapeutic use , Pulmonary Wedge Pressure/drug effects , Recombinant Proteins/administration & dosage , Recombinant Proteins/pharmacology , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/mortality , Shock, Cardiogenic/etiology
13.
Rev. bras. cir. cardiovasc ; 32(2): 96-103, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-843481

ABSTRACT

Abstract INTRODUCTION: The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization. Infusion of low dose recombinant human brain natriuretic peptide (rhBNP) at the time of AMI is well tolerated and could improve cardiac function. OBJECTIVE: The objective of this study was to evaluate the hemodynamic effects of rhBNP in AMI patients revascularized by emergency percutaneous coronary intervention (PCI) who developed cardiogenic shock. METHODS: A total of 48 patients with acute ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and whose hemodynamic status was improved following emergency PCI were enrolled. Patients were randomly assigned to rhBNP (n=25) and control (n=23) groups. In addition to standard therapy, study group individuals received rhBNP by continuous infusion at 0.005 µg kg−1 min−1 for 72 hours. RESULTS: Baseline characteristics, medications, and peak of cardiac troponin I (cTnI) were similar between both groups. rhBNP treatment resulted in consistently improved pulmonary capillary wedge pressure (PCWP) compared to the control group. Respectively, 7 and 9 patients died in experimental and control groups. No drug-related serious adverse events occurred in either group. CONCLUSION: When added to standard care in stable patients with cardiogenic shock complicating anterior STEMI, low dose rhBNP improves PCWP and is well tolerated.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Natriuretic Peptide, Brain/administration & dosage , Anterior Wall Myocardial Infarction/drug therapy , Percutaneous Coronary Intervention/mortality , ST Elevation Myocardial Infarction/drug therapy , Shock, Cardiogenic/etiology , Blood Pressure/drug effects , Recombinant Proteins/administration & dosage , Recombinant Proteins/pharmacology , Pulmonary Wedge Pressure/drug effects , Analysis of Variance , Natriuretic Peptide, Brain/therapeutic use , Natriuretic Peptide, Brain/pharmacology , Anterior Wall Myocardial Infarction/complications , Anterior Wall Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/mortality , Heart Rate/drug effects , Intra-Aortic Balloon Pumping/methods
14.
Medicine (Baltimore) ; 96(51): e9181, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29390456

ABSTRACT

The circulating concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) has been shown to be a diagnostic tool for the detection of heart failure. Several factors influence NT-proBNP levels including age, sex, and body mass index (BMI). Therefore, the diagnostic sensitivity of NT-proBNP level for heart failure is relatively higher, but its specificity is low. This study aims to improve the diagnostic accuracy rate of this test by including multiple variables in the diagnostic test.The suspected chronic heart failure outpatients were divided into heart failure with reduced ejection fraction, heart failure with mid-range ejection fraction, heart failure with preserved ejection fraction, and normal heart function groups. Area under the receiver-operating characteristic (ROC) curve, cut-off value, and logistic regression analysis were used to select the model variables, sensitivity and specificity.In all, 436 subjects enrolled into this study were divided in 2 groups: model establishment (n = 300) and model validation (n = 136). In the model establishment group, the area under the curve (AUC) and cut-off value of NT-proBNP was 0.926 and 257.4 pg/mL, respectively. When age, glomerular filtration rate, BMI, atrial fibrillation, and sex were entered into the diagnosis model, AUC, sensitivity, and specificity further increased to 0.955 (95% confidence interval [CI] 0.934, 0.976), 94.2% (from 93.0%), and 86.7% (from 74.2%). The ROC curve of corrected NT-proBNP diagnostic formula for heart failure was also significantly higher (P = .037).The corrected NT-proBNP diagnostic formula was found to improve the diagnostic accuracy of chronic heart failure.


Subject(s)
Echocardiography, Doppler/methods , Heart Failure/blood , Heart Failure/diagnostic imaging , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Age Factors , Aged , Aged, 80 and over , Area Under Curve , Biomarkers/blood , China/epidemiology , Chronic Disease , Databases, Factual , Diagnostic Tests, Routine/methods , Female , Heart Failure/epidemiology , Humans , Male , Middle Aged , ROC Curve , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Sex Factors
15.
Int J Clin Exp Med ; 8(12): 22440-9, 2015.
Article in English | MEDLINE | ID: mdl-26885226

ABSTRACT

The objective of this study was to determine the combination of left ventricular ejection fraction (LVEF) and individual electrocardiographic parameters related to abnormal depolarization/repolarization or baroreceptor sensitivity that had the best predictive value for major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS). Patients with ACS who underwent coronary angiography and percutaneous coronary intervention (PCI) were included in this prospective study. Ventricular late potential (VLP), heart rate turbulence (HRT), heart rate variability (HRV), and T wave alternans (TWA) parameters were measured using 24 h Holter monitoring 2-4 weeks after onset of ACS. Initial and follow-up LVEF was measured by ultrasound. Patients were followed for at least 6 months to record the occurrence of MACE. Models using combinations of the individual independent prognostic factors found by multivariate analysis were then constructed to use for estimation of risk of MACE. In multivariate analysis, VLP measured as QRS duration, HRV measured as standard deviation of normal RR intervals, and followup LVEF, but none of the other parameters studied, were independent risk factors for MACE. Areas under ROC curve (AUCs) for combinations of 2 or all 3 factors ranged from 0.73 to 0.76. Combinations of any of the three independent risk factors for MACE in ACS patients with PCI improved prediction and, because these risk factors were obtained non-invasively, may have future clinical usefulness.

16.
Arch Cardiovasc Dis ; 104(1): 17-28, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21276574

ABSTRACT

BACKGROUND: Previous studies have shown protective effects of brain natriuretic peptide (BNP) against the postmyocardial infarction (MI) remodelling process. The transcription factor NF-κB is known to play an important role after MI. AIMS: To investigate if NF-κB is involved in the protective effects of BNP against adverse post-MI remodelling. METHODS: Rats were randomly assigned to five groups: sham-operation; MI by coronary ligation; MI treated with chronic BNP infusion; MI treated with enalapril; MI treated with BNP+enalapril. Rats were closely monitored for survival rate analysis. Rats from each group were sacrificed on days 3, 7 and 28 postoperation. RESULTS: The results showed that chronic continuous BNP infusion achieved similar effects to enalapril therapy, as evidenced by improved survival rate within the 28-day observation period compared with MI group rats; this effect was closely associated with preserved cardiac geometry and performance. The treatment combination did not offer extra benefits in terms of survival rate. Both BNP and enalapril therapy produced higher heart tissue concentrations of cyclic guanosine monophosphate and lower expression levels of inflammatory cytokines, including tumour necrosis factor-α, interleukin-1 and interleukin-6. These benefits were associated with lower phosphorylation levels of NF-κB subunits IκBα, p50 and p65. While enalapril significantly inhibited extracellular matrix remodelling via regulation of the protein expression ratio of matrix metalloproteinase/tissue inhibitor of metalloproteinase and the activity of matrix metalloproteinase, these variables were not affected by BNP, indicating that the two therapies involve different mechanisms. CONCLUSION: Chronic BNP infusion can provide beneficial effects against adverse post-MI remodelling.


Subject(s)
Cardiovascular Agents/administration & dosage , Myocardial Infarction/drug therapy , Myocardium/pathology , Natriuretic Peptide, Brain/administration & dosage , Ventricular Function, Left/drug effects , Ventricular Remodeling/drug effects , Angiotensin II/metabolism , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Animals , Collagen/metabolism , Cyclic GMP/metabolism , Disease Models, Animal , Enalapril/pharmacology , Hemodynamics , I-kappa B Proteins/metabolism , Inflammation Mediators/metabolism , Infusion Pumps, Implantable , Infusions, Intravenous , Male , Matrix Metalloproteinase 2/metabolism , Matrix Metalloproteinase 9/metabolism , Myocardial Infarction/metabolism , Myocardial Infarction/pathology , Myocardial Infarction/physiopathology , Myocardium/metabolism , NF-KappaB Inhibitor alpha , NF-kappa B p50 Subunit/metabolism , Phosphorylation , Rats , Rats, Sprague-Dawley , Time Factors , Tissue Inhibitor of Metalloproteinase-1/metabolism , Transcription Factor RelA/metabolism
17.
Eur J Pharmacol ; 649(1-3): 293-300, 2010 Dec 15.
Article in English | MEDLINE | ID: mdl-20869962

ABSTRACT

Oxidative stress and inflammatory response induced by myocardial infarction play important roles in the development of sympathetic neural remodeling. The present study was designed to investigate whether resveratrol can improve sympathetic neural remodeling and hence cause less arrhythmias via its anti-oxidant and anti-inflammatory effects. Male Sprague Dawley rats were randomly assigned to either vehicle or resveratrol (1 mg/kg) treatment for 4 weeks post myocardial infarction. Another group of sham operated rats served as controls. Cardiac electrophysiology examination was performed to evaluate the severity of ventricular arrhythmias. Sympathetic neural remodeling characterized by heterogeneous nerve sprouting and sympathetic hyperinnervation was assessed by immunohistochemistry study. Western blotting and ELISA were used to evaluate inflammatory responses and oxidative stress was also quantified. Resveratrol treatment resulted in less episodes of inducible ventricular arrhythmias which was closely associated with attenuated sympathetic neural remodeling (P<0.001, respectively). Decreased nerve growth factor (NGF) expression was also observed in resveratrol treated rats in the peri-infarct area at 4 weeks after myocardial infarction (P<0.001). Interestingly, beneficial effects of resveratrol were also associated with less inflammatory responses and oxidative stress. Our data indicated that resveratrol can suppress sympathetic neural remodeling process after myocardial infarction via attenuated inflammatory responses and oxidative stress, which in turn leads to less inducibility of ventricular arrhythmias.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antioxidants/therapeutic use , Heart Ventricles/innervation , Myocardial Infarction/drug therapy , Stilbenes/therapeutic use , Sympathetic Nervous System/drug effects , Sympathetic Nervous System/physiopathology , Animals , Anti-Arrhythmia Agents/pharmacology , Anti-Arrhythmia Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Antioxidants/pharmacology , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/prevention & control , Biomarkers/metabolism , Heart Ventricles/drug effects , Heart Ventricles/pathology , Macrophages/drug effects , Macrophages/metabolism , Male , Myocardial Infarction/pathology , Myocardium/metabolism , Myocardium/pathology , Nerve Growth Factor/metabolism , Neurons/drug effects , Neurons/metabolism , Oxidative Stress/drug effects , Random Allocation , Rats , Rats, Sprague-Dawley , Resveratrol , Severity of Illness Index , Stilbenes/pharmacology
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