Association of Uric Acid and C-reactive Protein with the Severity of Coronary Artery Disease Using SYNTAX Score and Clinical SYNTAX Score.

BACKGROUND: The SYNTAX score (SXscore), an anatomical-based scoring tool reflecting the complexity of coronary anatomy, has been associated with the mortality and prognosis of coronary artery disease (CAD). Clinical SYNTAX score (CSS), incorporating clinical factors further augmented the utility of the SXscore to longer-term risk. C-reactive protein (CRP) is related to SXscore. Serum uric acid (UA) is associated with atherosclerosis and CAD. However, serum uric acid combined with CRP may better predict the SXscore and CSS. METHODS: A total of 208 patients (mean age 57.82 ± 9.39 years) with chest pain were included in this study. All selected subjects underwent coronary artery angiography and blood test. The relationship between serum UA, CRP and SXscore, and CSS were analyzed. RESULTS: Age and CRP had a positive correlation with SXs and CSS. DM and fasting glucose correlated with SXscore and CSS respectively. In multivariate regression, serum UA, age, fasting glucose, and body mass index (BMI) were significant discriminant factors of high CSS. The predictive accuracy of CRP for SXscore >0 and high CSS using receiver operator characteristic curves was set at the cut off point of 0.205 mg/dL and 0.145 mg/dL respectively, (sensitivity 70.9% and 98%, specialty 48% and 23.2%). CONCLUSION: Serum CRP is correlated with SXscore and CSS, serum UA is independently associated with CSS. CRP predicts high CSS at a lower level than it predicts SXscore. Thus, serum CRP combined with serum UA may be useful to predict SXscore and CSS.

The clinical application value of the plasma copeptin level in the assessment of heart failure with reduced left ventricular ejection fraction: A cross-sectional study.

This study aimed to evaluate the clinical applicability of the plasma copeptin level to assess heart failure with reduced left ventricular ejection fraction (HFrEF).One hundred thirty-one patients with HFrEF, 127 patients with heart failure with preserved left ventricular ejection fraction (HFpEF), and 119 healthy candidates were involved. The basic data and examination results of patients were collected. The heart function of the patients with HFrEF and HFpEF were graded on the basis of the criteria of New York Heart Association (NYHA) classification. The plasma copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were tested using enzyme-linked immunosorbent assays (ELISAs).The copeptin and NT-proBNP levels were higher in the HFrEF group than in the HFpEF group. The copeptin and NT-proBNP values increased as the NYHA grade increased in the patients with HFrEF. However, for the patients with HFpEF, the copeptin levels did not change markedly as the NYHA grade increased. The copeptin levels were positively correlated with the NT-proBNP levels in the patients with HFrEF; however, there was no correlation between the copeptin and NT-proBNP values in the patients with HFpEF.Copeptin is involved in the process of progression in patients with HFrEF and the copeptin values might be useful for HFrEF prediction and assessment in the clinic.

Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis.

BACKGROUND: The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies. However, few studies have used the rich information available from CCTA to detect functionally significant coronary lesions. We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions, using fractional flow reserve (FFR) as the gold standard. METHODS: We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age, 59.6 ± 10.2 years; 76.14% of males) who underwent CCTA, invasive coronary angiography, and invasive FFR measurement. An FFR <0.80 indicated hemodynamically significant coronary stenosis. Lesions were divided into two groups using an FFR cutoff value of 0.80. We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR. The statistical methods included unpaired t-test, Mann-Whitney U-test, and Spearman's correlation coefficients. RESULTS: Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80. Gai's score had the strongest correlation with FFR (r = -0.48, P < 0.01) and had a greater area under the curve = 0.72 (95% confidence interval: 0.61-0.82; P < 0.01) than the CACS of whole arteries and a single artery. CONCLUSIONS: Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR. However, Gai's plaque score was more predictive of FFR <0.80. Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization.

Intravascular Ultrasound Classification of Plaque in Angiographic True Bifurcation Lesions of the Left Main Coronary Artery.

BACKGROUND: Accurately, characterizing plaques is critical for selecting the optimal intervention strategy for the left main coronary artery (LMCA) bifurcation. Coronary angiography cannot precisely assess the location or nature of plaques in bifurcation lesions. Few intravascular ultrasound (IVUS) classification scheme has been reported for angiographic imaging of true bifurcation lesions of the unprotected LMCA thus far. In addition, the plaque composition at the bifurcation has not been elucidated. This study aimed to detect plaque composition at LMCA bifurcation lesions by IVUS. METHODS: Fifty-eight patients were recruited. The location, concentricity or eccentricity, site of maximum thickness, and composition of plaques of the distal LMCA, ostial left anterior descending (LAD) coronary artery and, left circumflex (LCX) coronary artery were assessed using IVUS and described using illustrative diagrams. RESULTS: True bifurcation lesions of the unprotected LMCA were classified into four types: Type A, with continuous involvement from the distal LMCA to the ostial LAD and the ostial LCX with eccentric plaques; Type B, with concentric plaques at the distal LMCA, eccentric plaques at the ostial LAD, and no plaques at the LCX; Type C, with continuous involvement from the distal LMCA to the ostial LCX, with eccentric plaques, and to the ostial LAD, with eccentric plaques; and Type D, with continuous involvement from the distal LMCA to the ostial LAD, with eccentric plaques, and to the ostial LCX, with concentric plaques. The carina was involved in only 3.5% of the plaques. A total of 51.7% of the plaques at the ostium of the LAD were soft, while 44.8% and 44.6% were fibrous in the distal LMCA and in the ostial LCX, respectively. CONCLUSIONS: We classified LMCA true bifurcation lesions into four types. The carina was always free from disease. Plaques at the ostial LAD tended to be soft, whereas those at the ostial LCX and the distal LMCA tended to be fibrous.

Intermittent Oxygen Inhalation with Proper Frequency Improves Overall Health Conditions and Alleviates Symptoms in a Population at High Risk of Chronic Mountain Sickness with Severe Symptoms.

BACKGROUND: Oxygen inhalation therapy is essential for the treatment of patients with chronic mountain sickness (CMS), but the efficacy of oxygen inhalation for populations at high risk of CMS remains unknown. This research investigated whether oxygen inhalation therapy benefits populations at high risk of CMS. METHODS: A total of 296 local residents living at an altitude of 3658 m were included; of which these were 25 diagnosed cases of CMS, 8 cases dropped out of the study, and 263 cases were included in the analysis. The subjects were divided into high-risk (180 ≤ hemoglobin (Hb) <210 g/L, n = 161) and low-risk (Hb <180 g/L, n = 102) groups, and the cases in each group were divided into severe symptom (CMS score ≥6) and mild symptom (CMS score 0-5) subgroups. Severe symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group (A group) or oxygen intake 7 times/week group (D group); mild symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group (A group), oxygen intake 2 times/week group (B group), and 4 times/week group (C group). The courses for oxygen intake were all 30 days. The CMS symptoms, sleep quality, physiological biomarkers, biochemical markers, etc., were recorded on the day before oxygen intake, on the 15th and 30th days of oxygen intake, and on the 15th day after terminating oxygen intake therapy. RESULTS: A total of 263 residents were finally included in the analysis. Among these high-altitude residents, CMS symptom scores decreased for oxygen inhalation methods B, C, and D at 15 and 30 days after oxygen intake and 15 days after termination, including dyspnea, palpitation, and headache index, compared to those before oxygen intake (B group: Z = 5.604, 5.092, 5.741; C group: Z = 4.155, 4.068, 4.809; D group: Z = 6.021, 6.196, 5.331, at the 3 time points respectively; all P < 0.05/3 vs. before intake). However, dyspnea/palpitation (A group: Z = 5.003, 5.428, 5.493, both P < 0.05/3 vs. before intake) and headache (A group: Z = 4.263, 3.890, 4.040, both P < 0.05/3 vs. before intake) index decreased significantly also for oxygen inhalation method A at all the 3 time points. Cyanosis index decreased significantly 30 days after oxygen intake only in the group of participants administered the D method (Z = 2.701, P = 0.007). Tinnitus index decreased significantly in group A and D at 15 days (A group: Z = 3.377, P = 0.001, D group: Z = 3.150, P = 0.002), 30 days after oxygen intake (A group: Z = 2.836, P = 0.005, D group: Z = 5.963, P < 0.0001) and 15 days after termination (A group: Z = 2.734, P = 0.006, D group: Z = 4.049, P = 0.0001), and decreased significantly in the group B and C at 15 days after termination (B group: Z = 2.611, P = 0.009; C group: Z = 3.302, P = 0.001). In the population at high risk of CMS with severe symptoms, oxygen intake 7 times/week significantly improved total symptom scores of severe symptoms at 15 days (4 [2, 5] vs. 5.5 [4, 7], Z = 2.890, P = 0.005) and 30 days (3 [1, 5] vs. 5.5 [2, 7], Z = 3.270, P = 0.001) after oxygen intake compared to no oxygen intake. In the population at high risk of CMS with mild symptoms, compared to no oxygen intake, oxygen intake 2 or 4 times/week did not improve the total symptom scores at 15 days (2 [1, 3], 3 [1, 4] vs. 3 [1.5, 5]; χ2 = 2.490, P = 0.288), and at 30 days (2 [0, 4], 2 [1, 4.5] vs. 3 [2, 5]; χ2 = 3.730, P = 0.155) after oxygen intake. In the population at low risk of CMS, oxygen intake did not significantly change the white cell count and red cell count compared to no oxygen intake, neither in the severe symptomatic population nor in the mild symptomatic population. CONCLUSIONS: Intermittent oxygen inhalation with proper frequency might alleviate symptoms in residents at high altitude by improving their overall health conditions. Administration of oxygen inhalation therapy 2-4 times/week might not benefit populations at high risk of CMS with mild CMS symptoms while administration of therapy 7 times/week might benefit those with severe symptoms. Oxygen inhalation therapy is not recommended for low-risk CMS populations.

[Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion].

OBJECTIVE: To compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO). METHODS: The patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years. RESULTS: A total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06). CONCLUSION: Our study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.

Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication.

BACKGROUND: Myocardial perfusion grade (MPG) is an accepted method of evaluating myocardial perfusion. However, it does not take into the account, the extent of the perfusion. We hypothesized that myocardial blush area times MPG (total blush) would be more accurate than simple MPG, and yield better prognostic information. METHODS: About 34 patients were recruited after they had consented to both coronary angiography (CAG) and single photon emission computed tomography (SPECT), and divided into two groups. A special dedicated computer was employed to calculate the total blush. The CAG was performed as a conventional way. Scintigraphic technetium 99m methoxyisobutyl-isonitrile rest and stress images were evaluated quantitatively. The comparison was made between stenosis versus chronic total occlusion (CTO), MPG 1, 2 versus MPG 3, percutaneous intervention (PCI) successful versus failure. A correlation was made between ejection fraction (EF) and myocardial perfusion by MPG, total blush, SPECT, and syntax score. RESULTS: The perfusion indices of total blush, summed difference score (SDS) and syntax score were insignificant between the two groups (P > 0.05). However, the left ventricular end diastolic volume was significantly larger in CTO (P < 0.05). The patients with stenosis had better MPG than with CTO (P < 0.05). The increased MPG was associated with increased total blush, higher syntax score, and EF (P < 0.05). Successful PCI resulted in better perfusion indicated by increased total blush, and MPG (P < 0.05) but successful PCI did not change syntax score, EF and SDS significantly. Multivariate linear analysis with EF as the dependent factor and syntax score, SDS, total blush, blush area, and MPG as the independent factors showed a significantly higher degree of correlation (R = 0.87, P < 0.05). CONCLUSION: After PCI the total blush and EF improved significantly indicating its potential application in the future.

Correlation between comprehensive evaluation of coronary artery lesion severity and long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome.

BACKGROUND: There is little known about long-term outcome data regarding acute coronary syndrome (ACS) in Chinese octogenarians (> 80 years old). Long-term outcomes of octogenarians with ACS may be associated with increased complicated coronary artery lesion severity. METHODS: We classified 536 consecutive octogenarians with ACS into four groups based on Gensini score. Survival and major adverse cardiac event (MACE) rates were calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify mortality predictors. The follow-up period was 27 (IQR15-36) months. RESULTS: The overall long-term mortality rate was 9.1% and increased from 3.0% in group 1 to 16.7% in group 4. Increasing coronary artery lesion severity was associated with increased long-term mortality and MACE rates. ROC curve analysis showed that the predictive cut-off value of Gensini score for mortality was 53. Gensini score provided significant reclassification of mortality (net reclassification index 0.195, P<0.01). Age, gender, heart rate, SBP, chronic renal failure, e-GFR, GRACE score, Gensini score, and ACS type were different between surviving and deceased patients. Notably, chronic renal failure (OR=2.55, P=0.036), GRACE score (OR=1.10, P=0.006), and Gensini score(OR=1.11, P=0.003) were the independent predictors of long-term mortality. CONCLUSIONS: Long-term mortality of octogenarians with ACS was associated with increased comprehensive coronary artery lesion severity. Gensini score was an effective parameter for evaluation of long-term mortality.

MiR-132 inhibits expression of SIRT1 and induces pro-inflammatory processes of vascular endothelial inflammation through blockade of the SREBP-1c metabolic pathway.

PURPOSE: Inflammation participates centrally in all stages of atherosclerosis (AS), which begins with pro-inflammatory processes and inflammatory changes in the endothelium, related to lipid metabolism. MicroRNA (miRNA) inhibition of inflammation related to SIRT1 has been shown to be a promising therapeutic approach for AS. However, the mechanism of action is unknown. METHODS: We investigated whether miRNAs regulate the SIRT1 and its downstream SREBP-lipogenesis-cholesterogenesis metabolic pathway in human umbilical vein endothelial cells (HUVECs). HUVECs were transfected with miR-132 mimics and inhibitors, and then treated with or without tumor necrosis factor α (TNFα). The effects of miR-132 on pro-inflammatory processes, proliferation and apoptosis were assessed. RESULTS: We identified that the relative 3' UTR luciferase activities of SIRT1 were significantly decreased in miR-132 transfected HUVECs (0.338 ± 0.036) compared to control (P = 0.000). miR-132 inhibited SIRT1 expression of mRNA level in HUVECs (0.53 ± 0.06) (P < 0.01) as well as proteins of SIRT1. mRNA expression and protein levels of SREBP (0.45 ± 0.07), fatty acid synthase (FASN) (0.55 ± 0.09) and 3-hydroxy-3-methylglutaryl CoA reductase (HMGCR) (0.62 ± 0.08) (P < 0.01), which are downstream regulated genes, were reduced in HUVECs by miR-132. MiR-132 promoted pro-inflammatory processes and apoptosis of HUVECs induced by TNF-α, and inhibited its proliferation, viability and migration. CONCLUSIONS: SIRT1 mRNAs are direct targets of miR-132. miR-132 controls lipogenesis and cholesterogenesis in HUVECs by inhibiting SIRT1 and SREBP-1c expression and their downstream regulated genes, including FASN and HMGCR. Inhibition of SIRT1 by miR-132 was associated with lipid metabolism-dependent pro-inflammatory processes in HUVECs. The newly identified miRNA, miR-132 represents a novel targeting mechanism for AS therapy.

Association between heme oxygenase 1 gene promoter polymorphisms and susceptibility to coronary artery disease: a HuGE review and meta-analysis.

We performed a systematic review and meta-analysis of heme oxygenase 1 gene (HO-1) promoter polymorphisms and susceptibility to coronary artery disease (CAD) based on eligible studies retrieved from electronic databases from 2002 to 2013. Eleven studies, involving 10,170 patients with CAD and 6,868 controls, were included. Overall, no significantly decreased risk of CAD was found in persons with the SS genotype of the HO-1 (GT)n repeat length polymorphism compared with those with the LL + SL genotype. However, decreased risks of CAD were observed in the Asian subgroup, the coronary-artery-narrowing ≥50% subgroup, the myocardial infarction subgroup, the age- and sex-matched subgroup, and the good-quality-reports subgroup. The primary heterogeneity in the studies came from age and sex matching and the extent of coronary stenosis. CAD risk was significantly decreased for persons with the AA genotype of the T(-413)A single-nucleotide polymorphism versus those with the TT genotype, but most of the studies showed that the allele distribution was inconsistent with Hardy-Weinberg equilibrium. In this meta-analysis, we found that the (GT)n SS genotype was associated with decreased risk of CAD after controlling for biases due to age and sex matching, extent of coronary stenosis, ethnicity, and study quality. The relationship between the T(-413)A single-nucleotide polymorphism and CAD should be interpreted more cautiously.

[Impact of coronary computed tomography angiography on patient triage strategies].

OBJECTIVE: To investigate the triaging pathways of patients after coronary computed tomography angiography (CCTA). METHODS: The patients undergoing CCTA were enrolled consecutively during the period from March 3, 2008 to June 23, 2009. The rate of coronary angiography (CAG) examinations after CCTA was calculated. The rates of normal CAG, medication, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) were compared between CCTA and direct CAG cohorts. RESULTS: A total of 8030 cases receiving CCTA and 3260 receiving direct CAG were included in the study. The CCTA patients had significantly fewer risk factors than those having direct CAG. Of the 8030 patients undergoing CCTA, 953 (12.03%) received further CAG and 6977 (87.97%) did not. Of the patients who received CAG after CCTA, 35 (3.7%) had normal CAG findings, 604 (63.4%) underwent PCI, 108 (11.3%) received conservative treatment with medications, and 206 (21.6%) underwent CABG. In the 3260 patients directly undergoing CAG, 706 (52.3%) underwent subsequent PCI, 142(4.4%) underwent CABG, 815(25.1%) received medications, and 579 (17.9%) had normal CAG findings. Comparison between the cases receiving direct CAG and CAG after CCTA showed that CCTA resulted in a significant increase in the revascularization rate (P<0.0001). CONCLUSION: CCTA can help prevent unnecessary CAG and allows more accurate patient triage.

Long-term prognostic impact of cystatin C on acute coronary syndrome octogenarians with diabetes mellitus.

OBJECTIVE: Cystatin C (Cys C) is a marker of renal dysfunction. Prior studies have shown that blood Cys C is related to the prognosis of coronary heart disease. The aim of the present study was to evaluate the long-term prognostic impact of Cys C on acute coronary syndrome (ACS) octogenarians with diabetes mellitus (DM). METHODS: We enrolled 660 consecutive ACS octogenarians who underwent coronary angiography and were classified into two groups based on diabetes. The baseline characters and Cys C level were measured on admission. Survival curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of mortality and of major adverse cardiac events (MACE) rate. RESULTS: There were 223 and 398 patients in groups DM and non-DM who fulfilled the follow-up. The average follow-up period was 28 (IQR 16-38) months. Diastolic blood pressure (DBP) was lower, ratios of hypertension and chronic renal failure (CRF), fasting blood glucose, HbA1c and Cys C levels were higher in DM group than those in non-DM group (P<0.01). The cumulative survival of DM group was significantly lower than that of non-DM group in the long term (P = 0.018). All cause mortality and MACE of DM group were higher than those of non-DM group (P<0.05). The plasma Cys C concentration (OR = 3.32, 95% CI = 1.18-10.92, P = 0.023) was the uniqueness independent predictor for long-term all cause mortality. The plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for MACE in DM group. ROC curve analysis showed that the predictive cut-off value of Cys C for mortality of DM group was 1.605 (0.718, 0.704). CONCLUSIONS: Cys C is an independent predictor for long-term mortality and MACE of ACS octogenarians with DM.

[Effect of angiotensin II and aldosterone on the proliferation of cardiac fibroblasts in rats].

OBJECTIVE: To investigate the effect of angiotensin II (ang II), aldosterone (ald) and their receptor antagonists losartan (los) and spironolactone (spi) on the proliferation and collagen production of cardiac fibroblasts (CFs) in rats. METHODS: CFs were isolated from neonatal SD rats by collagenase II method and purified with differential attachment and detachment method. The 3 or 4 passages of the CFs were divided into the following groups: angiotensin II, angiotensin II+aldosterone, aldosterone, angiotensin II+losartan, and aldosterone+spironolactone. The cell viability of the CFs was assessed by Cell Counting Kit-8 (CCK-8) after the drug administration. The mRNA and protein expression levels of COL1A1, COL3A1, MMP1 and TIMP1 were detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot respectively. RESULTS: Ang II and Ald facilitated the proliferation rate of the CFs independently compared with that in the control group (38.5% vs 28.5%; P<0.05), and the proliferation rate in the ang II+ald group was higher than that in the ang II group and ald group alone (54.4%, P<0.05). Los and spi inhibited the effect induced by ang II and ald respectively (P<0.05). Compared with the control group, ang II and ald significantly enhanced COL1A1, COL3A1 and MMP1 expression both at the mRNA and protein levels (P<0.05), but the TIMP1 expression was inhibited (P<0.05), which could be abolished by corresponding receptor antagonists los and spi (P<0.05). CONCLUSION: Ang II and ald can promote the proliferation of CFs, and the COL1A1 and COL3A1 expression is enhanced both at mRNA and protein levels. Ang II and ald have synergistic effect when they are used together, while los and spi may restrain the effect. The mechanism is probably linked with the balance of MMPs/TIMPs.

Correlation between major adverse cardiac events and coronary plaque characteristics.

BACKGROUND: Unstable plaque is believed to be responsible for major adverse cardiac events (MACE). OBJECTIVE: To determine whether coronary computed tomography angiography (CCTA) could be used to predict future MACE. METHODS: Patients undergoing CCTA between January 2008 and February 2010 were consecutively enrolled in the study. The hospital database was screened for patients who later developed acute ST segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) or cardiac death. Plaque scores were calculated and analyzed using one-way ANOVA to examine the relationship between plaque scores and MACE. RESULTS: Of the 8557 patients who underwent CCTA, 1055 had hospital records available for follow-up. During follow-up, 25 patients experienced MACE including death (six patients), heart failure (two patients), STEMI (11 patients) and NSTEMI (six patients). The plaque scores were significantly increased in patients who later died, developed heart failure or experienced STEMI (P<0.05). Calcification, erosion and severe stenosis were responsible for the events (P<0.05). Mild and moderate lesions, positive remodelling, drug-eluting stent placement, occlusion and diffuse lesions were not predictive of MACE (P>0.05). CONCLUSION: Severe calcification, erosion and severe stenosis predict death, heart failure and STEMI.

[An initial study on the feasibility of diagnosing myocardial ischemia with CT first-pass myocardial perfusion imaging at rest].

OBJECTIVE: To assess the feasibility and accuracy of CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of myocardial ischemia. Results of adenosine-induced myocardial perfusion scintigraphy (MPS) were used as gold standard. METHODS: Twenty-two patients with suspected or diagnosed coronary artery disease (CAD) were included and CT coronary angiography (CTCA) and MPS were performed within 2 weeks. CT first-pass MPI detected myocardial ischemia results through analyzing the raw date of CTCA were compared with MPS results. RESULTS: The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting myocardial ischemia were 92% (12/13), 78% (7/9), 86% (12/14), 88% (7/8) and 86% (19/22), respectively. CONCLUSION: CT first-pass MPI at rest could detect myocardial ischemia with an accuracy similar to that of MPS.

[Diagnosis of obstructive coronary artery disease using CT coronary angiography combined with CT first-pass myocardial perfusion imaging at rest].

OBJECTIVE: To assess the feasibility and accuracy of CT coronary angiography (CTCA) combined with CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of obstructive coronary artery disease (CAD). METHODS: Fifty-five patients, suspected or diagnosed as CAD, were performed with CTCA and CAG within 2 weeks. CT first-pass MPI detected myocardial ischemia through analyzing the raw date of CTCA. RESULTS: Comparison with the results of CAG, the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting obstructive CAD were 84.6%, 68.8%, 86.8%, 64.7% and 80.0%, respectively; and 92.3%, 93.8%, 97.3%, 83.3%, 92.7% for CTCA combined with CT first-pass MPI, respectively. CONCLUSION: CTCA combined with CT first-pass MPI at rest could detect obstructive CAD feasible and accurately.

[Conivaptan inhibites cell proliferation and collagen production of cardiac fibroblasts induced by arginine vasopressin].

OBJECTIVE: To investigate the effects of arginine vasopressin (AVP) and its receptor antagonist conivaptan (CON) on the proliferation of cardiac fibroblasts (CFs) and the production of collagen I and III. METHODS: CFs were isolated by collagenase II method and purified with differential attachment and detachment methods. The cell viability of CFs after AVP and/or CON administration was assessed by cell counting kit-8 (CCK-8). The expressions of COL1A1 and COL3A1 mRNA were detected by RT-PCR, and the protein levels of (collagen type 1, alpha 1, COL1A1) and COL3A1 were assessed by Western blotting. RESULTS: At 24 h after intervention, 10(-7); mol/L AVP promoted the proliferation of CFs in comparison with that in control group (P<0.01), and 10(-7); mol/L CON inhibited the effect significantly (P<0.01). At 12 h after intervention, 10(-7); mol/L AVP significantly enhanced the expressions of COL1A1 and COL3A1 at both mRNA and protein levels, and 10(-7); mol/L CON inhibited the effect again. CONCLUSION: AVP promoted the proliferation of CFs and enhanced the COL1A1 and COL3A1 expressions at both mRNA and protein levels, while CON could restrain the AVP effects partially.

Four-year clinical outcome in asymptomatic patients undergoing coronary computed tomography angiography.

BACKGROUND: Percutaneous coronary intervention (PCI) is indicated for angina with coronary stenosis. However, PCI for asymptomatic coronary stenosis remains controversial. We prospectively followed a group of patients for four years who underwent coronary computed tomography angiography (CCTA) for major adverse cardiac events (MACE). We hypothesized that the results of this trial would reliably reflect the natural outcome of the coronary disease. METHODS: Consecutive patients who underwent CCTA from June 2008 to May 2009 were selected. Those who could not be reached by telephone, had significant angina, had CT images that were not interpretable, or poor kidney and left ventricular (LV) function were excluded. The patients were divided into five groups: group A normal CCTA without stenosis, group B mild stenosis (1% - 49%), group C moderate stenosis (50% - 74%), group D severe stenosis (= 75%) and they were treated with optimal medical therapy (OMT) or PCI. The group E had PCI before the CCTA examination. The patients were then followed for MACE after different treatments. MACE included acute myocardial infarction (MI), heart failure (HF) and death. RESULTS: The patient population consisted of 419 patients. The follow-up time was (51 ± 5) months. The age was (60 ± 31) years. Male made up 67.78% of the population (n = 284). A total of 51 cases of MACE occurred including 25 MI, eight HF and 18 all-cause deaths. There was no MACE in group A. Although MACE occurred in two patients in group B, they were not attributed to cardiac death. We further compared the MACE in groups C-E and no significant difference was found (P > 0.05). However, a difference was detected among patients with unstable angina pectoris (UAP), stable angina pectoris (SAP), re-hospitalization, and cerebrovascular events from groups A-E (P < 0.05). The plaque scores were used to predict MACE. The scores progressively increased significantly with lesion severity (P < 0.05). Receiver operating curve (ROC) was performed to determine the sensitivity and specificity in predicting MACE. Our scores predicted MI with area of 0.76, predicted HF with area of 0.77, and predicted death with area of 0.70. CONCLUSIONS: Normal and mild lesions had very few events. With increased stenosis the MACE rate increased progressively. PCI did not significantly reduce the MACE in comparison with OMT in asymptomatic patients. Furthermore, UAP, re-hospitalization, and re-PCI were significantly increased in patients who were treated with PCI.