Clinical Feature Analysis of Fast Resting Heart Rate in Hypertension Patients / 中国循环杂志

To explore the clinical features and common complications of fast resting heart rate (RHR) in hypertensionpatients. Methods: We retrospectively analyzed the entire rest electrocardiogram data of Qingdao study 2000 and Xinyang study2005 in community population elder than 18 years including hypertension patients and non-hypertension subjects. Clinical complications as diabetes, coronary artery disease, hyperlipidemia and stroke, laboratory findings, RHR in ECG, body mass index (BMI), waist to hip ratio and office blood pressure were collected in all participants. Results: A total of 18183 participants were enrolled including 61.6% male, the average age was (45.2±12.7) years including 6763 hypertension patients. Compared with normal BP subjects, hypertension patients had the faster RHR (73.5±11.6) times/min vs (70.6±9.6) times/min, P<0.001 and more hypertension patients combining fast RHR (14.5% vs 6.4%), P<0.001. In hypertension patients, compared with normal RHR patients, fast RHR patients had the elder age (53.9±12.2) years vs (51.8±11.2) years, lower BMI (25.8±3.6) kg/m2 vs (26.4±3.4) kg/m2 and higher ratio of grade 3 hypertension (68.2%vs 59.0%), all P<0.001; higher levels of fasting blood glucose (6.0±2.4) mmol/L vs (5.6±1.5) mmol/L and triglyceride (2.0±1.8) mmol/L vs (1.7±1.3) mmol/L, both P<0.001, higher LDL-C (3.2±0.9) mmol/L vs (3.1±0.8) mmol/L, P=0.001;more patients with diabetes (6.6% vs 3.9%), P=0.007 and stroke (11.1% vs 8.3%), P=0.005. Multivariate regression analysis indicated that with adjusted traditional risk factors, fast RHR was positively related to stroke occurrence in hypertension patients (OR=1.306, 95% CI 1.021-1.671). Conclusion: Fast RHR happened more in hypertension patients than in normal BP subjects; it had the increased risk for stroke occurrence in hypertension patients.

Analysis for Clinical Features and Prognosis of Taksyasu Arteritis Combining Neurological Symptoms / 中国循环杂志

Objective: To explore the clinical features and prognosis in patients with Takayasu arteritis (TA) combining neurological symptoms. Methods: We retrospectively studied 274 TA patients combining neurological symptoms who admitted to our hospital from 2002-01 to 2013-10 for their clinical and imaging features with prognosis. Results: The ratio of male to female was 1:4.3 and the mean age of disease onset was at (28.2±11.2) years. The most common neurological symptom was dizziness (214/274 cases, 78.1%), most frequent type was type III TA (112 cases, 40.9%), most common affected artery was left subclavian artery (147 cases, 53.6%), and there were 77 cases (28.1%) with (3-4) branches of the aortic arch involvement. For stroke conditions, ischemic stroke was more frequently observed in patients with steno-occlusive lesions in subclavian artery and common carotid artery, while hemorrhagic stroke was more frequently found in patients with steno-occlusive lesions in descending aorta, abdominal aorta and/or renal artery. Heart failure was the most common cause of death, it was also the most common cardiovascular event in surviving cohorts. Conclusion: TA patients could have many neurological symptoms, which were related to the number and site of artery involvement.

Low estimated glomerular filtration rate is associated with high recurrence rate and poor prognosis of hemorrhage stroke.

This study investigated whether a low estimated glomerular filtration rate (eGFR) leads to a higher risk of stroke recurrence and a poor prognosis in hemorrhagic stroke patients. A total of 2000 stroke patients were recruited during 2000-2001 and prospectively followed up for a median of 4.5 years. The independent association of a low eGFR with stroke recurrence and poor prognosis was evaluated using Kaplan-Meier analysis and Cox regression models. Among the hemorrhagic stroke patients, the incidence rate of a low eGFR for the compound endpoints (stroke recurrence, myocardial infarction, and all-cause mortality) was greater than that of a normal eGFR (P=0.012). A similar result was observed for the incidence rate of recurrence and death caused by cardiovascular disease or stroke (Csdeath) (P=0.013, and P=0.001, respectively). After adjustment for age, sex, and other cardiovascular risk factors, a low eGFR was associated with a 2.93-fold increased risk of the compound endpoints (P=0.001, RR=2.93, 95% CI=1.58-5.43), 3.06-fold increased risk of recurrent stroke (P=0.003, RR=3.06, 95% CI=1.46-6.40), and 3.57-fold increased risk of Csdeath (P=0.005, RR=3.57, 95% CI=1.46-8.70) among hemorrhagic stroke patients. Among the hemorrhagic stroke patients, a low eGFR was a strong predictor of stroke recurrence and a poor prognosis.

Clinical Manifestation and Long-term Outcome in 566 Patients With Takayasu’s Arteritis / 中国循环杂志

Objective: To explore a single center large cohort of patients with Takayasu’s arteritis for their clinical manifestation and long-term outcome in China. Methods: We retrospectively analyzed 566 patients with Takayasu’s arteritis admitted in our hospital from 2002-01 to 2013-11 for their clinical characteristics, laboratory ifndings, angiographic features, treatment and long-term outcomes. Results: The patient’s ratio for female to male gender was 1 to 3.8 and the average onset age was (28.9 ± 12.0) years. The most common non-speciifc symptom, initial symptom and complication were fever (52/566 patients, 9.2%), dizziness (214 patients, 37.8%) and hypertension (392 patients, 69.3%) respectively. The patients with pulmonary artery and coronary artery involvement were 83 (14.7%) and 66 (11.7%) respectively, and 131 (23.1%) patients had faster erythrocyte sedimentation rate. The major vascular damage was steno-occlusive lesion and the most common involvement was left sub-clavian artery, which was observed in 278 (49.1%) patients. The treatments were mainly included in medication, interventional therapy, autologous blood vessel transplantation, artiifcial blood vessel transplantation and aortic valve replacement. There were 32 patients died during the mean follow-up period of (5.0 ± 0.2) years. Hypertension, complication and the progressive stage of disease were the major factors affecting prognosis in relevant patients (regression coefifcients: 4.664, 1.959 and 1.870 respectively, allP<0.05). Conclusion: Hypertension was the leading reason for patients’ hospital visit. Takayasu’s arteritis was closely related to cardiovascular disease, the early diagnosis and treatment were really important in clinical practice.

Pro731Ser mutation in the β-myosin heavy chain and hypertrophic cardiomyopathy in a Chinese pedigree / 中华心血管病杂志

<p><b>OBJECTIVE</b>To identify the casual mutation of a Chinese pedigree with hypertrophic cardiomyopathy (HCM), and to analyze the genotype-phenotype relationship.</p><p><b>METHODS</b>The coding exons of 26 reported disease genes were sequenced by targeted resequencing in the proband and the identified mutation were detected with bi-directional Sanger sequencing in all family members and 307 healthy controls. The genotype-phenotype correlation was analyzed in the family.</p><p><b>RESULTS</b>A missense mutation (c.2191C > T, p. Pro731Ser) in the 20th exon of MYH7 gene was identified. This mutation was absent in 307 healthy controls and predicted to be pathogenic by PolyPhen-HCM. Totally 13 family members carried this mutation, including 10 patients with HCM and 3 asymptomatic mutation carriers. The proband manifested severe congestive heart failure and 8 patients expressed various clinical manifestations of heart failure, including dyspnea, palpitations, chest pain, amaurosis or syncope. Five patients were diagnosed as HCM at the age of 16 or younger. One family member suffered sudden cardiac death.</p><p><b>CONCLUSIONS</b>The Pro731Ser of MYH7 gene mutation is a causal and malignant mutation linked with familiar HCM.</p>

Comparison of aortic dissection in Chinese patients with and without Marfan syndrome.

BACKGROUND: Aortic dissection is a life-threatening cardiovascular disease with high mortality. Little is known about comparisons of the clinical characteristics or the factors that influence the long-term prognosis of Chinese patients with aortic dissection with and without Marfan syndrome (MFS). METHODS: The authors studied the data of 246 patients with aortic dissection. The patients were hospitalised for aortic abnormalities from 2004 to 2008 in Fuwai Hospital. Medical charts were reviewed to obtain clinical data using a standardised data collection sheet. RESULTS: Of the 246 patients with acute aortic dissection, 56 had MFS. Compared with the non-MFS patients, those with MFS were considerably younger (mean ± SD age 35.27 ± 11.11 vs 54.11 ± 11.96 years, p<0.001) and had pre-existing hypertension much less commonly (5.4% vs 80.0%, p<0.001). The patients with MFS presented with a wider ascending aorta diameter (63.60 ± 9.00 vs 38.55 ± 9.44 mm, p<0.001) and a lower body mass index (20.14 ± 2.00 vs 25.62 ± 3.41, p<0.001) than the non-MFS patients. Overall, 91.1% of the MFS patients underwent surgical treatment, whereas 55.78% of the non-MFS patients accepted medical treatment. However, mortality in the two groups did not differ significantly (6 vs 17, p=0.527). Multivariate analysis showed that the aortic diameter (OR=1.072) was a risk factor and surgical treatment (OR=0.006) was a protective factor for the survival of MFS patients with aortic dissection. With increased diastolic blood pressure, mortality decreased in non-MFS patients with aortic dissection (OR=0.905). CONCLUSIONS: These clinical results could be useful for rapid assessment of the treatment and prognosis of patients with aortic dissection.

Analysis of clinical features of takayasu's arteritis in the elderly / 中华老年医学杂志

Objective To analyze the clinical features of takayasu's arteritis in elderly patients for improving their general management.Methods Twenty-six patients,aged over 60 years,with takayasu's arteritis were enrolled.The clinical manifestations and medical records were collected in detail and analyzed retrospectively.Results The mean age of the patients in our study was 64.0±3.8 years,four males and twenty-two females.Of all patients,nine were accompanied by coronary heart disease,seven by primary hypertension,four by diabetes mellitus,two by arrhythmia and one by subacute infective endocarditis.The frequent clinical manifestations were hypertension (n = 21,81%),dizzy (n=12.46%),chest pain (n=9,35%),pulselessness or weak pulse (n=7,27%).The clinical classification of this group showed brachiocephalic artery type (n = 8,30%),abdominal aorta type (n=4,15%),extensive type (n=11,58%) and pulmonary artery type (n=3,12%).Ten patients had elevated ESR level,six had elevated CRP level and fourteen had elevated ASO level.Two patients with diabetes mellitus died of serious complications.Conclusions Takayasu's arteritis in the elderly is usually accompanied by other cardiovascular diseases and risk factors.It is important to enhance the comprehensive treatment of these patients.

Clinical efficacy of renal artery stent as treatment for atherosclerotic renal artery stenosis in elderly patients / 中华老年医学杂志

Objective To evaluate the safety and clinical efficacy of renal artery stent treatment for severe atherosclerotic renal artery stenosis (ARAS) in the elderly. Methods In a prospective nonrandomized study in our hospital from January 2003 to April 2008, 147 consecutive elderly patients with ARAS (diameter reduction ≥ 65％) underwent percutaneous transluminal renal angioplasty and stenting (PTRAS) for resistant hypertension or reserving renal function. They were followed up for 6- 66 months and the effects of the procedure on renal function, blood pressure and cardiovascular events were observed. Results The success rate of PTRAS was 100％. During 6-66 months of follow up, both systolic and diastolic blood pressure were significantly decreased, and less antihypertensive medication was taken (P<0.01). Serum creatinine was significantly decreased during 6-48 months of follow up (P<0. 05) and did not change significantly during 54-66 months of follow up (P>0. 05). Blood urea nitrogen was significantly decreased during 6-24 months of follow up (P<0.05) and did not change significantly during 30-66 months of follow up (P>0.05). Complications related with the procedure occurred in 7 cases (4.8％). 17 patients failed to follow up (11.6％) and in 18 cases cardiovascular events occurred (12.2％), including 4 cases of renal events (2. 7％), 4 cases of myocardial infarction (2.7％), 2 cases of stroke (1.4％) and 8 cases of cerebral and cardiovascular events (5.4％) during 6-66 months of follow up. The survival rates of free-of-events at year 1, 2, 3, 4 and5 were 91.0%(121/133), 90.2%(83/92), 78.5%(51/65), 73.8%(31/42) and 54.8%(17/ 31), respectively. The survival rates at year 1, 2, 3, 4 and 5 were 94.0% (125/133), 90. 2% (83/ 92), 84.6%(55/65), 73. 8%(31/42) and 61.3%(19/31), respectively. Conclusions Renal artery stent as treatment for ARAS in the elderly has a beneficial effect on blood pressure control and on renal function during middle and long term follow up. The treatment may be helpful in reduction of cardiovascular events and mortality, which should be investigated further.

Relationship between polymorphisms of CX3CR1 gene and coronary artery disease: a Meta-analysis / 基础医学与临床

Objective To find whether CX3CR1 V249I and T280M are associated with CAD. Methods Database in English and Chinese, including PUBMED, EMbase, were searched to get the case-control studies on the associa-tion between V249I, T280M and CAD. Results Six studies were reviewed. The pooled OR of V249I compared to wild type allele was OR =0. 85(95% CI =0. 67 ～ 1. 08,P >0. 05). The pooled OR of T280M compared to wild type allele was OR =0. 82(95% CI =0. 70 ～ 0. 96, P < 0. 05). Conclusion The T280M is a protective factor of CAD, while the V249I is not associated with CAD.

Relationship between plasma high sensitivity C-reactive protein level and prognosis of Chinese patients with first-onset stroke / 中华神经科杂志

Objective To investigate the association between elevated levels of hsCRP and prognosis after stroke in Chinese patients.Methods Two hundred and ninety consecutive patients with firstonset stroke(197 ischemic and 93 hemorrhagic)and 290 age-and sex-matched control subjects without any cerebrovascular disease were studied.Plasma hsCRP level was measured and subsequent vascular events and death were determined in both groups over a 5-year period.Results Compared to control group,patients with stroke had higher plasma hsCRP level((3.3 ±3.8)vs(1.3±2.2)mg/L,t=8.048,P<0.01).Furthermore.within the group of patients with stroke,the mean plasma hsCRP level was higher in patients who experienced subsequent vascular events or death compared to patients without further complications ((4.4±4.3)vs(2.7±3.3)mg/L,t=3.496,P=0.001).Compared to the patients with lower hsCRP level(<1 mg/L),the relative risk for vascular events and death in stroke patients was 2.807(95%CI 1.544-5.495,P=0.001)in the hish hsCRP(>3 mg/L)patients.This increase of relative risk for vascular events and death in stroke patients persisted after the adjustment for age,sex and other cardiovascular risk factors such as hypertension and diabetes(OR 2.661,95%CI 1.323-5.352.P=0.006).Conclusions Patients presenting with stroke have higher levels of hsCRP compared to agematched controls.The degree of hsCRP elevation is correlated with the likelihood of subsequent VasCular events and death.These findings indicate that inerease of hsCRP level is associated with worsening prognosis after stroke in Chinese patients.

Prevalence of chronic rheumatic heart disease in Chinese adults.

OBJECTIVES: Rheumatic heart disease continues to be a common health problem in the developing countries. Though there is evidence indicating that rheumatic heart disease prevalence in China has decreased since the 1950s, no objective assessment of its present prevalence has been published. The study was designed to investigate the prevalence of chronic rheumatic heart disease in China. METHODS: We performed a community population based investigation from October 2001 to February 2002 in nine communities of nine provinces in China by using a multistage, random sample design. Rheumatic heart disease was diagnosed by echocardiographic imaging. Long-axis views of the mitral valve, color flow recordings were used to search for mitral and aortic regurgitations. M-mode and two-dimensional short- and long-axis views of the aortic root and left atrium were recorded for supporting the diagnosis. RESULTS: Of 9124 participants, 8652 completed the questionnaires and 8080 had comprehensive echocardiographic examinations. We found that 15 subjects had definite echocardiographic evidence of rheumatic heart disease. The rough prevalence of rheumatic heart disease was 186/100,000 adults (2 in 1000 adults). CONCLUSIONS: Rheumatic heart disease affected approximately 2 million middle-aged to elderly Chinese, thus constituting a significant health burden. We investigated only urban and suburban communities, the result may underestimate the real prevalence of the disease in China.

Bone morphogenetic protein receptor-II mutation Arg491Trp causes malignant phenotype of familial primary pulmonary hypertension.

A four-generation pedigree of familial primary pulmonary hypertension (FPPH) with 14 alive members was collected. In the family, three of the 14 alive familial members were diagnosed as FPPH. Mutations in bone morphogenetic protein receptor-II (BMPR-II) gene were screened by using sequencing analysis. A C-to-T transition at position 1471 in exon 11 of the BMPR-II gene was identified, resulting in an Arg491Trp mutation. We confirmed segregation of the mutation within the family and excluded the presence of the mutations in a panel of 240 chromosomes from normal individuals. No mutations were found in BMPR-II gene in other 10 patients with sporadic primary pulmonary hypertension. The Arg491Trp mutation is located in the kinase domain and predicted to disturb the kinase activity of BMPR-II. Total 7 familial members died at age 8-45 years with various symptoms, indicating other genetic or environmental modifiers involved in the modification of the clinical phenotype.

Immunochemical evidence that human apoB differs when expressed in rodent versus human cells.

LDL from human apolipoprotein B-100 (apoB-100) transgenic (HuBTg+/+) mice contains more triglyceride than LDL from normolipidemic subjects. To obtain novel monoclonal antibody (MAb) probes of apoB conformation, we generated hybridomas from HuBTg+/+ that had been immunized with LDL isolated from human plasma. One apoE-specific and four anti-apoB-100-specific hybridomas were identified. Two MAbs, 2E1 and 3D11, recognized an epitope in the amino-terminal 689 residues of apoB in native apoB-containing lipoproteins (LpBs) from human plasma or from the supernatant of human hepatoma HepG2 cells, but did not react with LpB from HuBTg+/+ mice or LpB secreted by human apoB-100-transfected rat McArdle 7777 hepatoma cells. 2E1 reacted weakly and 3D11 reacted strongly with apoB from HuBTg+/+ mice after SDS-PAGE. The lack of expression of the 2E1 and 3D11 epitopes on native LpB from HuBTg+/+ mice did not solely reflect the abnormal lipid composition of murine LpB. Both epitopes were detected in all human plasma samples tested and in all human plasma LpB classes. Therefore, human apoB expressed by rodent hepatocytes or hepatoma cells appears to adopt a different conformation or undergoes different posttranslational modification than apoB expressed in human hepatocytes or hepatoma cells.

Change of expression of cell/organs defense genes in brain tissue of rats with stroke-like episodes induced by complex environmental factors / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the effect of environmental risk factors on the development of stroke.</p><p><b>METHODS</b>With the use of cold-stimuli plus high-salt intake as environmental risk factors, a hypertension model with the complication of stroke was established in rats, then, a new technique, suppression subtractive hybridization (SSH), was used to identify the differential genes which specifically expressed in total cerebrum tissue of rat in each group. Comparison was made between control group and stroke group.</p><p><b>RESULTS</b>By the application of SSH, a total of 576 clones were generated in this study from two subtractive libraries, among them 456 clones were usable and were analyzed. Genes for cell/organs defense were down-regulated in stroke group and metabolism transcripts were shown to be up-regulated (P<0.01).</p><p><b>CONCLUSION</b>Cell/organs defense genes may play important roles in the development of stroke. The above findings suggested that environmental risk factors could genetically alter individual sensitivity to stroke.</p>

Effects of captopril on expression of calcineurin and NF-?B p65 in the heart of hypertensive rats / 中国病理生理杂志

AIM:To study the effect of captopril on calcineurin and NF-?B p65 in the signal transduction pathway of the cardiovascular remodeling in hypertensive rats.METHODS:Using a animal model of hypertension induced by abdominal aortic banding,the rats were treated with captopril for 10 weeks.The blood pressure was observed with a tail cuff method.The heart weight and heart weight/body weight were measured.The expression of calcineurin and NF-?B p65 were studied by using immunohistochemistry.RESULTS:After treated with captopril,the blood pressure of the model rats was decreased(P