Predictive value of serum iron on heart failure in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: In clinical practice, heart failure often occurs after acute myocardial infarction, and a new biomarker for its early prediction is urgently needed. The aim of this study was to investigate the relationship between serum iron and heart failure after acute ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 41 patients with heart failure after STEMI and 31 controls were included in the study. The demographic variables and baseline clinical characteristics of both groups were analyzed. RESULTS: There were no significant differences between patients with heart failure and controls in terms of demographic characteristics. There were significant differences in terms of serum iron, N terminal pro-B-type natriuretic peptide levels, left atrial diameter, and left ventricular ejection fraction. Binary logistic regression analyses demonstrated that serum iron (odds ratio [OR]: 0.804, 95% confidence interval [CI]: 0.699-0.924) and Tn-I (OR: 1.072, 95% CI: 1.011-1.137) were independent predictors for heart failure (p < .05, respectively). Receiver operating characteristic analysis showed that the area under the curve for serum iron was 0.808 (95% CI: 0.707-0.908, p < .01). The best cutoff value of serum iron was 11.87 µmol/L (sensitivity: 87.1%; specificity: 68.3%). CONCLUSIONS: Patients with heart failure after STEMI have lower serum iron levels than patients without heart failure after STEMI. Serum iron levels are a risk factor for heart failure after STEMI.

Effect of estimated plasma volume status and left atrial diameter on prognosis of patients with acute heart failure.

Objective: Acute heart failure (AHF) is a frequent cardiovascular emergency presenting with high mortality as well as readmission rates. The aim was to investigate the predictive value of estimated plasma volume status (ePVs) and left atrial diameter (LAD) for the prognosis of patients with AHF. Methods: Clinical profiles were collected from 259 cases of AHF patients at the Affiliated Hospital of Putian University between September 2019 and October 2021. Results: Six patients lost follow-up, resulting in 253 patients enrolled. Cardiogenic death and heart failure readmission during follow-up were defined as major cardiovascular events (MACE) group, other patients were defined as Non-MACE group. Apart from age, no significant differences were found between the two groups in demographics and comorbidities. The comparison between the two groups was statistically significant in terms of ePVs, LAD, and N-terminal-pro B-type natriuretic peptide (Nt-pro-BNP). On binary logistic regression analysis, ePVs (OR = 2.061, 95% CI 1.322∼3.214, P = 0.001), LAD (OR = 1.054, 95% CI 1.012∼1.098, P = 0.011), and Nt-pro-bnp (OR = 1.006, 95% CI 1.003∼1.010, P = 0.036) as predicting factors for MACE. Kaplan-Meier analysis indicated that the risk for cardiogenic death increasing with ePVs (p < 0.05). Conclusion: Estimated plasma volume status and LADs have some predictive value in assessing cardiogenic death and heart failure readmission in patients with AHF.

Carbohydrate antigen 125 combined with N-terminal pro-B-type natriuretic peptide in the prediction of acute heart failure following ST-elevation myocardial infarction.

The value of serum carbohydrate antigen 125 (CA125) combined with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the evaluation of acute heart failure (AHF) after ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the efficacy of CA125 combined with NT-proBNP in predicting AHF following STEMI. A total of 233 patients with STEMI were evaluated, including 39 patients with Killip II-IV and 194 patients with Killip I. The optimal cutoff point for predicting AHF was determined by receiver operating characteristic (ROC) curve, and the independent predictors of AHF were evaluated by multiple logistic regression. According to the cutoff value, it was divided into three groups: C1 = CA125 < 13.20 and NT-proBNP < 2300 (n = 138); C2 = CA125 ≥ 13.20 or NT-proBNP ≥ 2300 (n = 59); C3 = CA125 ≥ 13.20 and NT-proBNP ≥ 2300 (n = 36). Differences between groups were compared by odds ratio (OR). The levels of CA125 and NT-proBNP in AHF group were higher than those in non-AHF group (19.90 vs 10.00, P < .001; 2980.00 vs 1029.50, P < .001, respectively). The optimal cutoff values of CA125 and NT-proBNP for predicting AHF were 13.20 and 2300, both of which were independent predictors of AHF. The incidence of AHF during hospitalization was highest in C3 (69.44%), middle in C2 (20.34%) and lowest in C1 (1.45%). After adjustment for clinical confounding variables, compared with C1: C2 (OR = 6.41, 95% CI: 1.22-33.84, P = .029), C3 (OR = 19.27, 95% CI: 3.12-118.92, P = .001). Elevated CA125 and NT-proBNP are independent predictors of AHF in STEMI patients, and their combination can improve the recognition efficiency.

The Value of Sacubitril/Valsartan in Acute Anterior Wall ST-Segment Elevation Myocardial Infarction before Emergency Percutaneous Coronary Intervention.

BACKGROUND: Many patients present with heart failure with reduced ejection fraction (HFrEF) after acute anterior wall ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to evaluate the effect of preprocedural sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and left ventricular ejection fraction (LVEF) in patients with acute anterior STEMI undergoing percutaneous coronary intervention (PCI). METHODS: We enrolled patients with acute anterior wall STEMI who underwent emergency PCI at The Affiliated Hospital of Putian University from January 2019 to January 2021. Prior to PCI, patients were randomized to receive sacubitril/valsartan or valsartan. Nonculprit lesion vessels that require PCI were excluded. The primary endpoints included changes in NT-pro-BNP, LVEF, and rehospitalization for heart failure (HF) during the follow-up period. RESULTS: Out of 109 patients who were randomized, 55 were assigned to receive sacubitril/valsartan and 54 were assigned to receive valsartan. The decrease in NT-pro-BNP concentrations and the increase in LVEF were significantly greater in the sacubitril/valsartan group than in the valsartan group. CONCLUSIONS: In patients with acute anterior wall STEMI undergoing emergency PCI, preprocedural initiation of sacubitril/valsartan therapy increased LVEF and lower NT-pro-BNP concentrations compared with valsartan therapy.

Predictive Value of Red Blood Cell Distribution Width and Atrial Diameter in Paroxysmal Atrial Fibrillation: A Cross-Sectional Study.

BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia and is associated with deleterious consequences. In addition to worsening a patient's quality of life, AF is associated with stroke, heart failure, and increased mortality. Red blood cell distribution width (RDW) has been associated with an increased risk of death and adverse cardiovascular outcomes, while left atrial enlargement has been linked to atrial fibrillation (AF). However, the relationship among RDW, atrial diameter (AD), and paroxysmal AF is uncertain. The aim of this study was to investigate the relationship among RDW, atrial diameter, and paroxysmal AF. MATERIAL AND METHODS A total of 22 patients with paroxysmal AF and 100 patients with non-AF were included in the study. The demographic variables and baseline clinical characteristics of both groups were analyzed. RESULTS The demographics and comorbidities were comparable between the paroxysmal AF and control groups, except for BMI (body mass index). RDW, high-sensitivity C-reactive protein (hs-CRP) levels, NT-pro-BNP levels, MPV/PLT (mean platelet volume/total platelet count), LAD, RAD, and CHA2DS2-VASc score were higher in the paroxysmal AF group versus the control group (P<0.05). Binary logistic regression analyses demonstrated that RDW (OR: 2.557, 95% CI: 1.481~4.414), Hs-CRP(OR: 1.445, 95% CI: 1.144~1.825), MPV/PLT (OR: 1.342, 95% CI: 1.047~1.720), LAD (OR: 1.068, 95% CI: 1.007~1.132), and CHA2DS2-VASc score (OR: 1.645, 95% CI: 1.042~2.597) were independent predictors for paroxysmal AF (P<0.05, respectively). The ROC analysis showed that the area under the curve for LAD was 0.692, the area under the curve for RAD was 0.566, the area under the curve for RDW was 0.811, and the area under the curve for MPV/PLT was 0.671. CONCLUSIONS LAD, RDW, and MPV/PLT were associated with paroxysmal AF.

The Significance of Apolipoprotein-A in the Long-Term Death of Patients with STEMI.

OBJECTIVE: To analyze apolipoprotein-A for its predictive value for long-term death in individuals suffering from acute ST-segment elevation myocardial infarction following percutaneous coronary intervention. METHODS: We selected patients suffering from acute ST-segment elevation myocardial infarction who underwent emergency PCI at the Affiliated Hospital of Putian University from January 2017 to August 2019. The patients were divided into a high-Apo-A group and low-Apo-A group, and we observed all-cause deaths of patients in the 2 groups within 2 years. RESULTS: The ROC curve analysis indicated the best critical value for predicting 2-year mortality as 0.8150 (area under the curve was 0.626, sensitivity 75.1%, and specificity 51.9%). There was no statistical difference among the two groups in gender, age, lesion vessel, and comorbidities. The two groups had statistically significant differences in apolipoprotein-B/A, high-density lipoprotein, apolipoprotein-A, and hypersensitivity C-reactive protein. Correlation analysis showed a significant negative correlation between apolipoprotein-A and hypersensitive C-reactive protein. The results of the 24-month analysis indicated the incidence of all-cause mortality as higher in the low-Apo-A group, and Kaplan-Meier survival analysis showed the same trend. CONCLUSION: Apolipoprotein-A can predict the potential for long-term mortality among individuals having acute ST-segment elevation myocardial infarction.

Advances in miR-132-Based Biomarker and Therapeutic Potential in the Cardiovascular System.

Atherosclerotic cardiovascular disease and subsequent heart failure threaten global health and impose a huge economic burden on society. MicroRNA-132 (miR-132), a regulatory RNA ubiquitously expressed in the cardiovascular system, is up-or down-regulated in the plasma under various cardiac conditions and may serve as a potential diagnostic or prognostic biomarker. More importantly, miR-132 in the myocardium has been demonstrated to be a master regulator in many pathological processes of ischemic or nonischemic heart failure in the past decade, such as myocardial hypertrophy, fibrosis, apoptosis, angiogenesis, calcium handling, neuroendocrine activation, and oxidative stress, through downregulating target mRNA expression. Preclinical and clinical phase 1b studies have suggested antisense oligonucleotide targeting miR-132 may be a potential therapeutic approach for ischemic or nonischemic heart failure in the future. This review aims to summarize recent advances in the physiological and pathological functions of miR-132 and its possible diagnostic and therapeutic potential in cardiovascular disease.

Protective Effects of Sacubitril/Valsartan on Cardiac Fibrosis and Function in Rats With Experimental Myocardial Infarction Involves Inhibition of Collagen Synthesis by Myocardial Fibroblasts Through Downregulating TGF-ß1/Smads Pathway.

Objectives: To investigate the effect and mechanism of sacubitril/valsartan on myocardial fibrosis in rats following experimental myocardial infarction and in TGF-ß1-treated myocardial fibroblasts. Methods: Male Sprague-Dawley (SD) rats were subjected to coronary artery ligation to establish myocardial infarction and intragastrically fed vehicle, valsartan (Val, 32 mg/kg, once-daily) or sacubitril/valsartan (Sac/Val, 68 mg/kg, once-daily) for 4 weeks. In parallel, myocardial fibroblasts (MFs) isolated from neonatal SD rats were exposed to hypoxia and treated with TGF-ß1 (5 ng/ml) plus vehicle, Val (107-10-5 M) or Sac/Val (107-105 M). Rat cardiac function and fibrosis were measured by echocardiography and histological method, respectively. MFs viability and collagen synthesis were determined by cell counting kit-8 and enzyme-linked immunosorbent assay, respectively. Protein expressions of TGF-ß1, Smad3, phosphorylated Smad3 (p-Smad3), and p-Smad3 subcellular localization were detected by immunoblotting and immunocytochemistry. Results: Sac/Val significantly improved cardiac structure and function in rats after myocardial infarction, including decreased left ventricular end-diastolic diameter and interventricular septal thickness, increased ejection fraction, and reduced myocardial collagen volume fraction and type Ⅰ and type Ⅲ collagen levels, and this effect was superior to that of Val. Besides, Sac/Val inhibited myocardial TGF-ß1 and p-Smad3 protein expression better than Val. Mechanically, Sac/Val significantly attenuated TGF-ß1-induced proliferation and collagen synthesis of MFs, and inhibit Smad3 phosphorylation and nucleus translocation, and this effect outperformed Val. Overexpression and silencing of Smad3 enhanced and reversed the inhibitory effects of Sac/Val on TGF-ß1-induced collagen synthesis by MFs, respectively. Conclusions: Sacubitril/valsartan improves cardiac function and fibrosis in rats after experimental myocardial infarction, and this effect is related to the inhibition of collagen synthesis in myocardial fibroblasts by inhibiting the TGF/Smads signaling pathway.

Predictive value of neutrophil to lymphocyte ratio and red cell distribution width on death for ST segment elevation myocardial infarction.

There are many clinical scoring criteria for predicting the risk of death in patients with acute ST-segment elevation myocardial infarction (STEMI), but most of the indicators are complex to calculate and are not suitable for use in primary hospitals. Neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) are blood routine indicators that are easy to obtain and may help primary hospitals to evaluate the risk of death in patients with STEMI. Our aim was to explore the predictive value of NLR combined with RDW in the long-term prognosis of patients with STEMI after emergency percutaneous coronary intervention (PCI). A total of 181 patients with STEMI who underwent emergency PCI in the Affiliated Hospital of Pu-tian University from January 2017 to August 2018 were selected. Clinical profile, prognosis of all patients were collected. P value < 0.05 was considered significant. In all patients, cardiovascular death during the follow-up period was defined as cardiovascular death group, and surviving during the follow-up period was defined as survival group. There were no significant differences in demography and comorbidities between the two groups. The differences between the two groups in NLR, RDW, C-reactive protein, N-terminal-pro B type natriuretic peptide were statistically significant (P < 0.01). Binary logistic regression analysis showed that NLR (OR = 1.122, 95% CI 1.041 ~ 1.210, P = 0.003) and RDW (OR = 1.288, 95% CI 1.126 ~ 1.472, P = 0.0005) were important predictors of mortality in patients with STEMI (P < 0.05). Kaplan-Meier analysis showed that as the NLR increased, the risk of death increased (P < 0.001). In conclusion, NLR and RDW are independent predictors of cardiovascular death in patients with STEMI, and they have a certain predictive value.

Protective Effects of 1,25 Dihydroxyvitamin D3 against High-Glucose-Induced Damage in Human Umbilical Vein Endothelial Cells Involve Activation of Nrf2 Antioxidant Signaling.

AIM: To explore the protective effects and related mech-anisms of 1,25 dihydroxyvitamin D3 (1,25(OH)2D3) on en-dothelial dysfunction under hyperglycemic conditions. METHODS: Cultured human umbilical vein endothelial cells (HUVECs) were treated with normal glucose (glucose concentration of 5.5 mmol/L), high glucose (glucose concentration of 33 mmol/L), and high glucose plus 1,25(OH)2D3, respectively. Cell viability and apoptosis, intracellular reactive oxygen species (ROS) and nitric oxide (NO) contents, antioxidant enzyme activities, proinflammatory cytokine mRNA levels, and expression levels of proteins involved were measured. RESULTS: High glucose decreased HUVEC viability, promoted ROS production and apoptosis, and reduced NO generation, which was associated with decreased activities of antioxidant enzymes and increased levels of proinflam-matory cytokines. 1,25(OH)2D3 treatment enhanced HUVEC viability, attenuated ROS generation and apoptosis, and -increased NO production, which was accompanied by -enhanced antioxidant enzyme activities and reduced -proinflammatory factors. Mechanically, 1,25(OH)2D3 promoted nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) in a vitamin D receptor (VDR)-dependent manner, and Nrf2 siRNA abolished the antioxidative and -anti-inflammatory effects of 1,25(OH)2D3. CONCLUSIONS: 1,25(OH)2D3 attenuates high-glucose-induced endothelial oxidative injury through upregulation of the Nrf2 antioxidant pathway in a VDR-dependent manner.

Prognostic value of carbohydrate antigen 125 combined with N-terminal pro B-type natriuretic peptide in patients with acute heart failure.

BACKGROUND: The objective was to explore the value of serum carbohydrate antigen 125 (CA125) combined with N-terminal pro B-type natriuretic peptide (NT-proBNP) in predicting the clinical prognosis of patients with acute heart failure (AHF). METHODS: We prospectively observed 213 patients with AHF. CA125 (U/ml) and NT-proBNP (pg/ml) were dichotomised based on ROC curve analysised prognostic cutpoints, and a variable with four groups was formed (CA125 and NT-proBNP): C1 = CA125 < 47.6 and NT-proBNP <3790 (n = 100); C2 = CA125 < 47.6 and NT-proBNP ≥3790 (n = 29); C3 = CA125 ≥ 47.6 and NT-proBNP < 3790 (n = 26); C4 = CA125 ≥ 47.6 and NT-proBNP ≥3790 (n = 58). Kaplan-Meier curve was drawn and multivariate COX regression analysis was performed to analyse the prognostic efficacy of CA125 combined with NT-ProBNP in patients with AHF. RESULTS: The levels of CA125 and NT-proBNP in death group were obviously higher than those in non-death group [56.20 (45.70, 78.00) vs 31.10 (19.48, 47.68), p < 0.001; 5619.00 (2924.00, 10066.00) vs 2203.00 (1460.50, 5070.25), p < 0.001]. The ROC curve showed that the best cut-off values of CA125 and NT-proBNP for predicting the prognosis of AHF were 47.6 and 3790, respectively. Multivariate COX regression analysis showed that CA125 ≥ 47.6 and NT-proBNP ≥ 3790 were independent predictors of 1-year all-cause death in patients with AHF (HR = 3.05, 95%CI: 1.50-6.20, p = 0.002) and (HR = 2.34, 95%CI: 1.19-4.61, p = 0.014). At 12 months, 55 deaths (25.8%) were identified. The cumulative rate of mortality was highest for patients in C4 (56.9%), intermediate for C2 and C3 (24.1% and 34.6%, respectively), and lowest for C1 (6.0%), and p-value for trend <0.05. After adjusting for established clinical risk factors, compared with C1: C2 (HR = 4.58, 95%CI: 1.53-13.77, p = 0.007), C3 (HR = 5.24, 95%CI: 1.85-14.82, p = 0.002), C4 (HR = 7.75, 95%CI: 3.09-19.45, p < 0.001). CONCLUSION: Elevated CA125 is an independent predictor of poor prognosis in patients with AHF, and combined with NT-proBNP can improve the efficiency of risk identification.

Effects of body mass index and gender on left atrial size in Chinese hypertensive patients.

BACKGROUND: Left atrial enlargement (LAE) is a common cardiac structural change in patients with hypertension, and obesity could further promote LAE. However, little is known about the effect of overweight on left atrial size, and if there is a gender difference of the effect. The aim of this study was to analyze the effects of different body mass index (BMI) grades (normal weight, overweight, and obesity) on left atrial size in both male and female patients with hypertension. METHODS: A total of 710 patients with hypertension were divided into 3 study groups: normal weight group (BMI < 24 g/m2, n = 302), overweight group (24 kg/m2 ≤ BMI < 28 kg2, n = 318), and obesity group (BMI ≥28 kg/m2, n = 90). The clinical data, echocardiographic indexes and left atrial size were obtained from all the subjects. Pearson correlation analysis was used to analyze the correlation between clinical variables and left atrial diameter (LAD)/left atrial diameter index (LADI), and stepwise regression evaluation was used to study the relevant factors affecting LAD/LADI among all patients, male and female patients for possible gender difference. RESULTS: The significant difference in LADI was noted in the three study groups with obesity group of 23.96 ± 2.90 mm/m, overweight group of 22.50 ± 3.02 mm/m and normal weight group of 21.08 ± 2.80 mm/m, respectively (P < . 05). After adjusting for age and gender, there was still significant difference in LADI among the three groups (P < . 05). The correlation between BMI and LADI was higher than that between systolic blood pressure (SBP) and diastolic blood pressure (DBP) (r = 0.348 vs 0.092 and -0.068, respectively, P < .05). After adjusting for other influencing factors, there was still a significant correlation between BMI and LADI (ß = 0.326, P < .001), but no correlation was found between SBP and DBP (P > .05). For each additional unit of BMI, LAD increased by 0.034 mm and LADI increased by 0.305 mm/m. Multiple linear regression analysis showed that BMI, left ventricular mass index (LVMI), age and female gender were independently correlated with LADI (P < .05). And BMI was the most significant influencing factor of LADI in male patients (ß = 0.350, P < .001), followed by LVMI (ß = 0.343, P < .001). While in female patients, LVMI was the most significant (ß = 0.353, P < .001), followed by BMI (ß = 0.302, P < .001). CONCLUSION: Overweight and obesity were significantly associated with LAE in hypertensive patients, with obesity more significant than overweight. While BMI had the greatest correlation with LAE in male, LVMI was the most important determinant of LAE in female. Therefore, in addition to weight loss, more attention should be paid to early inhibition of left ventricular remodeling in female with hypertension.

Role of Vitamin D in Patients with Heart Failure with Reduced Ejection Fraction.

Heart failure (HF) with reduced ejection fraction (HFrEF) presents as the severest phenotype on the spectrum of HF. Although great progress has been made with respect to its treatment over the past 3 decades, morbidity and mortality remain high, posing a big burden on human health. Recent evidence suggests vitamin D has a critical role in maintaining heart health through activation of the vitamin D receptor expressed in cardiomyocytes, and vitamin D deficiency may be implicated in the pathophysiology of HFrEF through activation of the renin-angiotensin system, impaired calcium handling, exaggerated inflammation, secondary hyperparathyroidism, pro-fibrotic properties, and proatherogenic potential. Additionally, epidemiological data disclosed that vitamin D deficiency is highly prevalent in patients with HFrEF and is associated with poor clinical outcomes. However, randomized control trials of vitamin D supplementation in HF, especially in HFrEF, have shown inconsistent results. Thus, this article aims to review the epidemiology, pathophysiology, and prognostic value of vitamin D deficiency in HF, with a special focus on randomized control trials associated with vitamin D supplementation in patients with HFrEF.