[Speckle tracking analysis of left atrial phasic function in patients with hypertension].

OBJECTIVE: To assess left atrial (LA) phasic function in hypertension (HT) and to evaluate its relationship with left ventricular diastolic function. METHODS: Cross-sectional data of 738 population (149 non-HT as control, and 589 HT were further grouped into normal left ventricular diastolic function, mild diastolic dysfunction and moderate/severe diastolic dysfunction sub-groups) in an urban community of Beijing were used. LA global longitudinal strain in late diastole (Sa), early diastole (Se), and total strain (Stot = Sa+ Se), strain rate in late diastole (SRa), systole (SRs), and early diastole (SRe) were measured using off-line speckle-tracking echocardiography analyzing software, and were compared between non-HT and HT groups, and among HT sub-groups. RESULTS: LA reservoir [Stot: 22.7% ± 5.9% vs. 21.0% ± 5.8%, P = 0.002; SRs: (1.1 ± 0.3)/s vs. (1.0 ± 0.3)/s, P = 0.033] and conduit [Se: 11.1% ± 4.8% vs. 9.6% ± 4.2%, P = 0.001; SRe: (1.0 ± 0.4)/s vs. (0.9 ± 0.3)/s, P < 0.001] indexes were reduced significantly in HT, while contraction (Sa & SRa) indexes were similar to those of non-HT. CONCLUSION: LA reservoir and conduit functions are impaired in HT and deteriorate with left ventricular diastolic dysfunction. LA contraction is preserved in HT with normal and mild diastolic dysfunction while impaired in moderate/severe diastolic dysfunction.

[Correlation between anthropometric parameters and arteriosclerosis biomarker in the middle-aged and the elderly].

OBJECTIVE: To investigate the correlation between anthropometric indices and arteriosclerosis detection indicators in the middle-aged and the elderly. METHODS: A cross-sectional descriptive study was made of 1 626 individuals (diabetics patients 23.37%, hypertensive subjects 39.48% and healthy individuals 37.15%), aged 45 to 90 years [mean age: (61.60 ± 10.22) years)] in Shijingshan District, Beijing. Their measurements: body mass index (BMI), waist circumference (WC), and waist to height ratio (WHtR). Arterial stiffness was assessed according to brachial-ankle pulse wave velocity (baPWV), intima-media thickness (IMT), augmentation index (AI) and ankle-brachial index (ABI), which were measured by noninvasive detectors and equipment. The correlations between the various indicators were analyzed. RESULTS: The percentages of the hypertensive and diabetic groups of central obesity (male WC>85 cm, female WC>80 cm or WHtR>0.5) and of general obesity (BMI>28 kg/m²) were significantly higher than those of the healthy group (P<0.01). The difference between the two disease groups was not significant (P>0.05). There was a moderate positive correlation between the measures of abdominal obesity (WHtR and WC) and the general obesity indicators (BMI) (r=0.710 and 0.716). In the healthy group, WC and WHtR showed positive correlation with baPWV, IMT and ABI, and negative correlation with AI75. BMI showed positive correlation with IMT and negative correlation with AI75, and no correlation with baPWV and ABI. There was negative correlation between BMI and baPWV in the diabetic group. In the hypertension group, we found negative correlation between BMI and baPWV, maximum IMT, AI75, and also between WC and AI75. The simple regression straight line of baPWV versus the anthropometric parameters showed that the regression equations were y=0.949+1.379 x (baPWV vs. WHtR, R² = 0.046, P<0.001) and y=1.133+0.006x (baPWV vs. WC, R² = 0.027, P<0.001), respectively. baPWV and BMI did not have a linear relationship (P=0.62). CONCLUSION: WHtR and WC are superior to BMI indices in predicting arteriosclerosis. Anthropometric measurements for central obesity are good predictors of cardiovascular risk.

[Relationship between radial augmentation index and other indices for evaluating arteriosclerosis].

OBJECTIVE: To investigate the relationship between radial augmentation index (AI) and other noninvasive indices for evaluating arteriosclerosis. METHODS: From April to June 2010, a cross-sectional survey was performed in two communities of Shijingshan District, Beijing, China. This study involved 1 752 subjects (aged 23 to 90 years). AI was measured using Colin pulse wave detection device HEM9000AI. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were measured using Colin noninvasive arteriosclerosis tester VP-1000. Color Doppler flow imaging was used to measure intima-media thickness (IMT) of the bilateral carotid arteries. RESULTS: Compared with the control group, baPWV≥14 m/s, ABI≤0.9 and IMT≥0.9 mm groups showed no significant difference in AI75 (P>0.05). Hypertensive individuals had significantly higher baPWV than the healthy group. Elderly hypertensive individuals with diabetes mellitus or (and) dyslipidemia had lower ABI than the control group. There was no significant difference of AI75 between the disease groups and the healthy group (P>0.05). Pearson correlation analysis showed that AI75 was associated with women, central aortic systolic pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, and inversely associated with body mass index, waist hip ratio, triglycerides, fasting serum glucose, and not associated with age (r=0.045, P=0.064). There was negative correlation between AI75 and ABI, IMT. AI75 was positively correlated with baPWV in the male group (r=0.101, P=0.005), but not correlated in the female group. Partial correlation analysis found that AI75 was inversely associated with ABI, baPWV and IMT. There was negative correlation between AI75 and baPWV, IMT in the female and male groups, and no correlation between AI75 and ABI (P>0.05). Multivariate gradual regression analysis demonstrated that the independent positive correlation factors of AI75 included female, age, waist hip ratio, central aortic systolic pressure, and the negative correlation factors were body mass index, height, fasting serum glucose (R(2)=0.372). CONCLUSION: The lack of correlation of radial augmentation index with indices for evaluating arteriosclerosis suggests that AI is not a sensitive and reliable index for evaluating the degree of arterial stiffness.

[Plasma osteopontin level and left ventricular remodeling in patients with acute myocardial infarction].

OBJECTIVE: To investigate the change of plasma osteopontin level during the progress of acute ST-segment elevation myocardial infarction, as well as its association with the left ventricular remodeling and prognosis. METHODS: In the study, 61 patients with acute ST-segment elevation myocardial infarction were recruited. Blood samples were taken at admission, on the 3rd day and 7th day of admission, while 63 healthy blood donors were employed as normal controls. There plasma osteopontin levels were measured by ELSIA. RESULTS: Compared with the normal controls, the plasma osteopontin levels of the patients with acute ST-segment elevation myocardial infarction were significantly higher at admission [(96.51±37.22) µg/L vs. (54.50±28.17) µ g/L, P<0.001], reached the peak value on the 3rd day, and dropped down on the 7th day. The correlation analysis showed that the plasma osteopontin level positively correlated with age and left ventricular end-systolic volume index 3 months after acute myocardial infarction, and negatively correlated with left ventricular ejection fraction 3 months after acute myocardial infarction. The follow-up study found that the plasma osteopontin level did not predict mortality, re-infarction, stroke, revascularization or hospitalization due to heart failure. CONCLUSION: In patients with acute ST-segment elevation myocardial infarction, the elevated plasma level of osteopontin might be associated with the left ventricular remodeling.

Plasma catestatin level in patients with acute myocardial infarction and its correlation with ventricular remodelling.

BACKGROUND: The evaluation of ventricular remodelling and functional recovery is essential in predicting the prognosis of patients with acute myocardial infarction (AMI). OBJECTIVE: To determine the plasma catestatin level in patients with AMI, and investigate the association between plasma catestatin and heart function, and with left ventricular remodelling (LVR). METHODS: Fifty-eight consecutive patients who were admitted within 12 h of the onset of their ST-segment elevation myocardial infarction symptoms between 1 October 2009 and 30 June 2011 were prospectively recruited. Circulating catestatin was measured by ELISA. All patients underwent an echocardiography examination during the first week; 31 patients had a second echocardiography examination 3 months after the myocardial infarction. RESULTS: Plasma catestatin at the time of admission was significantly higher in patients than in normal controls. The level increased further in the first week after AMI. Three months after AMI, the plasma catestatin level of patients was comparable to that of normal controls. The plasma level of catestatin correlated with anterior AMI and left ventricular ejection fraction (LVEF) in the acute stage. Compared with patients without LVR, those with LVR had significantly higher level of plasma brain natriuretic peptide on day 7 and a significantly higher level of plasma catestatin on admission and on days 3 and 7 (p=0.033, p=0.001, p=0.006, p=0.021, respectively). CONCLUSIONS: Plasma catestatin levels were raised after AMI. An early increase of catestatin correlated with anterior AMI and LVEF. Plasma catestatin after the onset of AMI might be associated with the magnitude of progressive ventricular remodelling 3 months after AMI.

[Association between left ventricular twist/untwist and diastolic dysfunction of high cardiovascular risk population in the community].

OBJECTIVE: To assess the association between left ventricular (LV) twist and untwist with the severity of diastolic dysfunction of high cardiovascular risk population in the community. METHODS: This cross-sectional survey was performed in high cardiovascular risk people with normal left ventricular (LV) ejection fraction in an urban community of Beijing (n = 620). Normal LV diastolic function was defined in 305 subjects, mild diastolic dysfunction in 266 subjects and moderate/severe diastolic dysfunction in 49 subjects. Peak LV twist, peak twist velocity, peak untwist velocity and untwist rate were measured in apical and basal short-axis images using speckle tracking echocardiography. RESULTS: Peak LV twist was similar among subjects with normal diastolic function, mild diastolic dysfunction and moderate/severe diastolic dysfunction. Peak twist velocity [(129.3 ± 45.3)°/s vs. (118.0 ± 36.2)°/s] and untwist velocity [(-132.9 ± 50.4) °/s vs. (-121.2 ± 41.4)°/s] were significantly higher in mild diastolic dysfunction group than in normal diastolic function group (all P < 0.01) and similar between normal diastolic function and moderate/severe diastolic dysfunction group (P > 0.05). Untwist rate of moderate/severe diastolic dysfunction decreased significantly than that of normal diastolic function [(41.9 ± 32.9)°/s vs. (57.7 ± 36.2) °/s, P < 0.01] and mild diastolic dysfunction group [(41.9 ± 32.9)°/s vs. (60.9 ± 39.9) °/s, P < 0.01]. CONCLUSIONS: Twist and untwist parameters are increased/preserved in population with normal systolic function and mild diastolic dysfunction and "normalized" or reduced in those with advanced diastolic dysfunction. The maintaining (if not increasing) of LV twist in early diastolic dysfunction might serve as a compensatory mechanism in case of reduced myocardial relaxation in these subjects.

[Association between serum uric acid and brachial ankle pulse wave velocity in Beijing community residents].

OBJECTIVE: To observe the relationship between serum uric acid and brachial ankle pulse wave velocity (ba-PWV) in Beijing community individuals. METHODS: This epidemiological survey was performed in residents of two communities from Shijingshan District in Beijing from 2007 to 2008. Cardiovascular risk factors and ba-PWV were measured. Two thousand five hundred and forty three individuals with both ba-PWV and serum uric acid measurements were included. Ba-PWV ≥ 1400 cm/s was defined as abnormal. The individuals were divided into four groups (Q1, Q2, Q3 and Q4 group) according to the gender-specific quartiles of serum uric acid. Univariate logistic regression was used to evaluate the relation between various cardiovascular risk factors and ba-PWV abnormality. Multivariate logistic regression was used to evaluate the relation between serum uric acid and ba-PWV abnormality after adjusting for other cardiovascular risk factors. RESULTS: Body mass index, triglyeride and prevalence of hypertension increased with increasing levels of serum uric acid (all P < 0.01). Univariate logistic regression analysis showed that age, gender, smoking, hypertension, systolic blood pressure, diastolic blood pressure, diabetes, body mass index, total cholesterol, triglyeride and estimated glomerular filtration rate were related with ba-PWV abnormality (all P < 0.01). Compared with Q1 group, ba-PWV abnormality OR value of Q4 group was 1.73 (95%CI: 1.34 - 2.22, P < 0.01). Multivariate logistic regression revealed that ba-PWV abnormality OR value of Q4 group was 1.66 (95%CI: 1.16 - 2.37, P < 0.01 ) after adjusting for age, gender, smoking, hypertension, systolic blood pressure, diastolic blood pressure, diabetes, body mass index, total cholesterol, triglyeride and estimated glomerular filtration rate when compared with Q1 group and OR values were 1.55 (95%CI: 0.88 - 2.74, P > 0.05) and 1.65 (95%CI: 1.04 - 2.64, P < 0.05) in male and female respectively. CONCLUSION: Increased serum uric acid was independently associated with ba-PWV abnormality in Beijing community residents.

Elevated serum cystatin C is an independent predictor of cardiovascular events in people with relatively normal renal function.

BACKGROUND: Serum level of cystatin C could predict morbidity and mortality for cardiovascular disease in patients with coronary heart disease. However, the predictive value of cystatin C for cardiovascular events in subjects with relatively normal renal function, especially in Asian populations, has rarely been investigated. The current study investigated the relationship between cystatin C and cardiovascular events in a community-based population in Beijing. METHODS: Residents (n=724) with relatively normal renal function (estimated glomerular filtration rate [eGFR] =60 ml/min per 1.73 m2), who attended a community hospital in an urban district of Beijing, were recruited in the study. Risk factors for cardiovascular events were analyzed. RESULTS: Compared with subjects without cardiovascular events, those with cardiovascular events were older (p<0.000001) and had a higher proportion of males (p<0.01), those with diabetes (p<0.05) and smokers (p<0.05). Subjects with cardiovascular events had lower levels of serum high-density lipoprotein cholesterol (HDL-C) and eGFR than those without (p<0.05, p<0.01, respectively). The serum level of cystatin C was significantly higher in subjects with cardiovascular events than in subjects without cardiovascular events (p<0.01). Multivariable logistic regression analysis showed that the independent predictors of cardiovascular events were age, hypertension and serum level of cystatin C (higher than 0.88 mg/L). CONCLUSIONS: Besides the traditional risk factors, a higher level of serum cystatin C might be another independent risk factor for cardiovascular events, even in those with relatively normal renal function.

[Relation between aortic root dimension and cardiovascular disease].

OBJECTIVE: To analyze the relation among aortic root dimension (ARD) measured by echocardiography, cardiovascular disease risk factors and cardiovascular disease in adult Beijing community population. METHODS: Echocardiography was performed in 1041 individuals in a suburban community of Beijing from 2004 to 2005. ARD and other echocardiographic parameters including left atria dimension, left ventricular mass, septal and posterior wall thickness and dimension were analyzed. Histories of cardiovascular disease as well as risk factors were obtained. Spearman correlation was used to determine the relation between ARD and other cardiovascular risk factors. Multifactorial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of ARD and cardiovascular disease. RESULTS: Ascending aortic dimension (AAD) and mean root dimension (MRD) were positively associated with age, weight, BMI, systolic and diastolic blood pressure, left atria dimension, left ventricular mass, left ventricular septal and posterior wall thickness, and left ventricular dimension. With the lowest quintile of AAD and MRD as the reference, ORs for the highest quintile of AAD for specific cardiovascular diseases in female were as follows: stroke (OR = 2.20, 95%CI: 1.03 - 4.72, P = 0.04), chronic heart failure (OR = 2.62, 95%CI: 1.49 - 4.61, P = 0.001), total cardiovascular disease (OR = 2.52, 95%CI: 1.51 - 4.21, P < 0.001). ORs of MRD were as follows: chronic heart failure (OR = 2.19, 95%CI: 1.26 - 3.80, P = 0.01), total cardiovascular disease (OR = 2.20, 95%CI: 1.32 - 3.68, P = 0.002). After adjustment for age, BMI, smoking status, TC, hypertension, diabetes mellitus, the ORs were not statistically significant (P > 0.05). CONCLUSION: ARD was positively associated with several CHD risk factors, but was not independent risk factor for cardiovascular disease. ARD may act as an intermediate risk factor for cardiovascular disease. Combined ARD and traditional cardiovascular disease risk factors might enhance the predict power for cardiovascular disease.

[Location and expression of apo(a) and apoB in peripheral blood of patients with cardiovascular disease].

OBJECTIVE: To explore the relationship between the severity of cardiovascular disease with the expression of apolipoprotein(a) [apo(a)] and apolipoprotein B (apoB) in peripheral blood and their location in peripheral blood cells. METHODS: In this report, we selected 4 patients with angiography which indicated that three coronary arteries were narrowed and 5 control patients with normal angiography. Arterial blood was collected and analyzed for lipid parameters in plasma. The mRNA expression of apo(a) and apoB in peripheral white blood cells and platelets were determined by RT-PCR and their protein expression by western blot. Moreover, the expression and location of apo(a) and apoB in white blood cells were determined by confocal microscopy and computer 3D analysis. RESULTS: In plasma, levels of high density lipo-protein-cholesterol (HDL-C) and polipoprotein A-I(apoA-I) in cardiovascular disease (CVD) patients were significantly less than those in the control patients[(0.62+/-0.05) mmol/L, (0.78+/-0.08) mmol/L vs (0.81+/-0.15) mmol/L, (0.9+/-0.07) mmol/L, P<0.05], but the concentration of other plasma lipid parameters was not different. The size of apo(a) isoforms was not reversely related to the severity of cardiovascular disease and the most commonly occurring phenotype of apo(a) was S4.The expression of apoB in platelets in cardiovascular disease patients was less than that in the control patients by 25.1% (optical density value 0.67+/-0.18 vs 1.00+/-0.10, P<0.05),but the expression of apo(a) was not different between the two groups (optical density value 0.43+/-0.18 vs 0.61+/-0.40, P>0.05). Studies with confocal microscopy indicated that proteins of apo(a) and apoB were co-expressed by a few cells of leukocytes and the ratio of apoB/apo(a) in cardiovascular disease patients was significantly less than that in the control patients (optical density value 1.60+/-0.12 vs 4.40+/-0.35, P<0.05). In platelets and leukocytes, mRNA of apo(a) or apoB was not detectable. CONCLUSION: Our studies indicate that peripheral blood cells can carry apo(a) and apoB, furthermore the contents of apoB and apo(a) in cells are different between cardiovascular disease patients and patients with normal coronary artery.

[Relation between inflammation related cytokines and myocardial microcirculatory reperfusion state].

OBJECTIVE: To observe the dynamic fluctuation of inflammatory cytokines (IL-1beta, TNFalpha) and anti-inflammatory cytokine (IL-10) in acute myocardial infarct (AMI) patients before and after recanalization of infarct related artery (IRA) and analyze the relationship between fluctuation of cytokines and reperfusion state of myocardial tissue. METHODS: (1) In 22 AMI patients and 8 healthy subjects, plasma IL-1beta, TNFalpha and IL-10 were measured with ELISA before emergency percutaneous coronary interposition (PCI), 12 h and 24 h post-intervention. (2) The 22 AMI patients were further divided into 2 groups according to ST-segment change in ECG at 2h after reperfusion: group A, good reperfusion of myocardium, ST decrease >or= 70% (n = 12) and group B, poor reperfusion of myocardium, ST decrease < 70% (n = 10). The change of plasma levels of IL-1beta, TNFalpha and IL-10 of the two groups was compared. RESULTS: (1) Plasma TNFalpha and IL-10 in group A and B were not significantly higher those that the healthy controls (P > 0.05) before emergency PCI, but IL-1beta was significantly higher (P < 0.05). Plasma IL-1beta and TNFalpha in group A and B and IL-10 in group B at 12 h and 24 h post-intervention were significantly higher than those before PCI (P < 0.01, P < 0.05, P < 0.05), while IL-10 in group A was not (P > 0.05). (2) Plasma IL-1beta, TNFalpha and IL-10 in group B were not higher than those in group A before PCI, but they were significantly higher at 12 h post-PCI (P < 0.01, P < 0.05, P < 0.05) and IL-1beta and IL-10 were still higher at 24 h post-PCI (P < 0.05). The increment of IL-10 was significantly less than that of IL-1beta and TNFalpha in group A and B (P < 0.01, P < 0.05). CONCLUSIONS: Cytokines may be involved in myocardial ischemia-reperfusion injury and increase of inflammatory cytokines may be a marker of poor myocardial microcirculatory reperfusion.