Atherogenic dyslipidaemia and cardiovascular events in patients with diabetes or pre-diabetes and stable coronary artery disease: a prospective, cohort study.

OBJECTIVE: The aim of the study was to investigate the impacts of triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) dyslipidaemia on prognosis in coronary artery disease (CAD) patients with different glucose metabolism status. DESIGN: An observational cohort study. SETTING/PARTICIPANTS: A total of 3057 patients with stable CAD were consecutively enrolled and divided into three groups according to different glucose metabolism status. Atherogenic dyslipidaemia (AD) was defined as TG ≥1.7 mmol/L and HDL-C <1.0 mmol/L for men or <1.3 mmol/L for women. The patients were further classified into six subgroups by status of AD. All subjects were followed up for the cardiovascular events (CVEs). PRIMARY OUTCOME MEASURES: The primary endpoints were cardiovascular mortality, non-fatal myocardial infarction and non-fatal stroke. RESULTS: During a median follow-up of 6.1 years, 308 (10.1%) CVEs occurred. No significant difference in the occurrence of CVEs was observed between normal glucose regulation (NGR) and pre-diabetes (pre-DM) groups (HR: 1.25, 95% CI 0.89 to 1.76) while DM group presented 1.45-fold higher risk of CVEs (HR: 1.45, 95% CI 1.02 to 2.05). When the participants were categorised according to combined status of two parameters, the cardiovascular risk was significantly elevated in pre-DM or DM plus AD group compared with the NGR plus non-AD group (HR: 1.76, 95% CI 1.10 to 2.80 and HR: 1.87, 95% CI 1.17 to 2.98). CONCLUSIONS: The present study suggested that the presence of AD might affect the prognosis in patients with DM or pre-DM and stable CAD.

Lipoprotein(a) as a marker for predicting coronary collateral circulation in patients with acute myocardial infarction.

Aim: The aim of the present study was to examine the predictive value of lipoprotein(a) (Lp[a]) levels for coronary collateral circulation (CCC) in patients with acute myocardial infarction (AMI). Method & methods: A total of 409 consecutive patients with AMI were enrolled for this study. Patients were divided into two groups according to rentrop grades assessed by coronary angiography: bad (n = 277) and good CCC group (n = 132). Result: Patients with bad CCC had a higher level of Lp(a) than that with good CCC (median Lp[a] 219.1 vs 122.0 mg/l). The area under the receiver-operating characteristic curves of Lp(a) in predicting bad CCC was 0.647 (95% CI: 0.592-0.702) with the cut-off value of 199.0 mg/l. Conclusion: Our data firstly suggested that Lp(a) might be a useful marker for CCC after AMI.

Use of cationic microbubbles targeted to P-selectin to improve ultrasound-mediated gene transfection of hVEGF165 to the ischemic myocardium.

Gene therapies have been applied to the treatment of cardiovascular disease, but their use is limited by the need to deliver them to the right target. We have employed targeted contrast ultrasound-mediated gene transfection (TCUMGT) via ultrasound-targeted microbubble destruction (UTMD) to transfer therapeutic genes to specific anatomic and pathological targets. Phospholipid microbubbles (MBs) with pcDNA3.1-human vascular endothelial growth factor 165 (pcDNA3.1-hVEGF165) plasmids targeted to P-selectin (MB+P+VEGFp) were created by conjugating monoclonal antibodies against P-selectin to the lipid shell. These microbubbles were divided into four groups: microbubble only (MB), microbubble+P-selectin (MB+P), microbubble+pcDNA3.1-hVEGF165 plasmid (MB+VEGFp), and microbubble+ P-selectin+pcDNA3.1-hVEGF165 plasmid (MB+P+VEGFp). The reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) results showed that the VEGF gene was successfully transfected by TCUMGT and the efficiency is increased with P-selectin targeting moiety. UTMD-mediated delivery of VEGF increased myocardial vascular density and improved cardiac function, and MB+P+VEGFp delivery showed greater improvement than MB+VEGFp. This study drew support from TCUGMT technology and took advantage of targeted ultrasound contrast agent to identify ischemic myocardium, release pcDNA3.1-hVEGF165 recombinant plasmid, and improve the myocardial microenvironment, so promoting the restoration of myocardial function.

Triglyceride glucose index for predicting cardiovascular outcomes in patients with coronary artery disease.

BACKGROUND: Triglyceride glucose (TyG) index is a novel marker for metabolic disorders and recently it has been reported to be associated with cardiovascular disease (CVD) risk in apparently healthy individuals. However, the prognostic value of TyG index in patients with stable coronary artery disease (CAD) is not determined. METHODS: We conducted a nested case-control study among 3,745 patients with stable CAD. Patients were followed up for 11,235 person-years. The cardiovascular events (CVEs) were defined as all-cause death, non-fatal myocardial infarction (MI), stroke and post-discharge revascularization [percutaneous coronary intervention (PCI) coronary artery bypass grafting (CABG)]. In total, 290 (7.7%) patients with CVEs and 1,450 controls were matched according to age, gender, previous history of PCI or CABG and the duration of follow-up. TyG index was calculated as formula: ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. RESULTS: Multivariable Cox proportional hazards models revealed that TyG index was positively associated with CVEs risk (hazard ratio: 1.364, 95% confidence interval: 1.100-1.691, P=0.005). The Kaplan-Meier analysis indicated that patients within the highest quartile of TyG index presented the lowest event-free survival (P=0.029). Moreover, a 1-standard deviation (SD) increment in TyG index was associated with 23.2% [hazard ratio (HR): 1.232, 95% confidence interval (95% CI): 1.084-1.401] higher risk of CVEs, which was superior to other triglyceride or glycemic related markers. CONCLUSIONS: The present study, firstly, showed that TyG index was positively associated with future CVEs, suggesting that TyG may be a useful marker for predicting clinical outcomes in patients with CAD.

[Exploration on an ultrasonographic imaging reporting and data system in malignancy grading of thyroid nodules].

OBJECTIVE: To explore the values of ultrasonographic features in differentially diagnosing benign and malignant thyroid nodules, and attempt to establish a quantitative ultrasound classification system. METHODS: We retrospectively analyzed 20 ultrasound features of 926 thyroid nodules in 527 patients. Using logistic regression analysis, we obtained the probability function for predicting the malignancy in thyroid nodules and established a preliminary ultrasound classification system. RESULTS: The ages of patients with thyroid nodules was older than that of the patients with thyroid carcinoma (t = 6.496, P < 0.001). The correctness rate of ultrasonic diagnosis was 80.1%. The logistic multivariate regression analysis showed that among all ultrasonographic features, aspect ratio ≥ 1, obscure boundary, irregular margin, significant internal hypoecho, internal hypoecho, internal micro-calcifications, posterior echo attenuation, thyroid capsule invasion, abnormal adjacent lymph nodes, and ultrasonic elastography 5-point evaluation scores > 3 were contributing factors for thyroid carcinoma. The equation was P (us) = 1 /[1+e(-)Z], where z is the logit of malignant thyroid nodule, and taking P (us) > 0.50 as boundary value, the prediction accuracy rate was 84.1%. Using this model, 92.2% of the thyroid nodules were predicted as nodular goiter, and 69.4% of the thyroid carcinomas were correctly predicted. P (us) was stratified into four levels: Level 1: 0-16% malignancy; Level 2: 17%-50% malignancy; Level 3: 51%-70% malignancy; and level 4: 71%-100% malignancy. CONCLUSIONS: The quantitative thyroid imaging reporting and data system developed in this study makes ultrasound reports more objective, normalized and standardized. It can be used to evaluate the malignancy risk of thyroid nodules and help to make right decision in clinics.

[Aortic elastic properties and its clinical significance in intracranial aneurysms].

OBJECTIVE: To investigate the aortic elastic properties and its clinical significance in intracranial aneurysms (IAs). METHODS: One hundred and seven IAs patients (57 with hypertension) and 108 healthy subjects were recruited. The internal aortic diameters in systole and diastole were measured by the M-mode echocardiography, the aortic elasticity indexes were calculated and compared. RESULTS: The aortic distensibility (DIS) was lower and the aortic stiffness index (SI) was higher in IAs patients than those in controls (both P <0.001). DIS was lower and SI was higher in IAs patients with hypertension (IAs-HP) than those in IAs with no hypertension (P <0.001). Similar results were obtained when the aortic elasticity index were adjusted for body surface area and body mass index. CONCLUSION: Abnormal aortic elasticity is a common finding in IAs patients and hypertension is closely related to the severity of aortic elasticity.

Giant left atrial thrombus associated with ablation for atrial tachycardia.

We report a very rare case of giant left atrial thrombus (size: 7.2 x 4.5 mm(2)) associated with radiofrequency catheter ablation for atrial tachycardia in a 72-year-old man. After 4 weeks of anticoagulation with warfarin, a repeat echocardiogram demonstrated partial resolution of the thrombus (size: 4.5 x 2.6 mm(2)) without systemic embolization.

Biventricular pacemaker implantation in a patient with isolated noncompaction of the right ventricular myocardium.

Isolated noncompaction of the ventricular myocardium is an unclassified cardiomyopathy and is thought to be due to arrest of myocardial morphogenesis. Fetal arrhythmias may occur in approximately half of the patients and account for the death in this disorder. We describe a patient with isolated noncompaction of the right ventricular myocardium in whom implantation of biventricular pacemaker was thought to be effective to prevent the risk of sudden cardiac death and complications.

Cerebral infarction in an adult patient with right ventricular hypertrabeculation/noncompaction.

Ventricular hypertrabeculation/noncompaction (VHT) is a rare congenital anomaly, and usually involves the left ventricle (LVHT), with the right ventricle (RVHT) being infrequently involved. Clinical manifestations are highly variable, ranging from no symptoms to disabling congestive heart failure, arrhythmias, systemic thromboemboli and sudden death. We report a case of right ventricular hypertrabeculation/noncompaction (RVHT) presenting as cerebral infarction.

[Assessment of postsystolic shortening of left ventricle in dilated cardiomyopathy using tissue velocity imaging].

OBJECTIVE: To evaluate the postsystolic shortening (PSS) of different segments of left ventricle (LV) and its meanings in dilated cardiomyopathy (DCM). METHODS: Twenty-two normal controls and 14 DCM patients underwent tissue velocity imaging (TVI) to obtain the regional velocity profiles of 18 segments of LV. The peak velocities of isovolumic contraction phase (V(IC)), systolic phase (V(S)), and PSS (V(PSS)), the time of V(PSS) (T(PSS)) was measured and the ratio of V(PSS) to V(IC) (V(PSS)/V(IC)), and ratio of V(PSS) to V(S) (V(PSS)/V(S)) were calculated. The active and passive PSS were compared by the standard of V(PSS)/V(IC). RESULTS: Physiologic PSS was detected only in minority segments of normal subjects and pathologic PSS was detected in all segments of DCM patients. Compared with the physiologic PSS, The V(PSS), V(PSS)/V(IC), and V(PSS)/V(S) of the pathological PSS were increased and the T(PSS) of pathologic velocity of PSS (V(PSS)) were prolonged. Compared with the passive PSS segments, the V(PSS) and V(PSS)/V(S) of active PSS were increased and the T(PSS) of active V(PSS) segments were prolonged. CONCLUSION: PSS exists in LV, probably having relation with ischemia-like condition of myocardium in DCM patients. There are significant differences between physiologic and pathologic PSS, and between active and passive PSS.

Tissue Doppler imaging study of right ventricular myocardial systolic activation in subjects with pulmonary arterial hypertension.

BACKGROUND: Tissue Doppler imaging (TDI) has provided an objective means to quantify global and regional left ventricular (LV) and right ventricular (RV) function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension (PAH). METHODS: A total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments (RV basal lateral wall, basal septal, and LV basal lateral) on apical 4-chamber view: systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view. RESULTS: Compared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter (RA: (4.5 +/- 1.2) cm vs (3.0 +/- 0.8) cm, P < 0.05 and RV: (4.8 +/- 1.9) cm vs (3.4 +/- 0.5) cm, P < 0.05) and reduced RV fractional area change; (35 +/- 14)% vs (56 +/- 9)%, P < 0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls (P < 0.05). Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension (r = -0.82). CONCLUSIONS: In PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction.

Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma.

INTRODUCTION: Early detection of pneumothorax in multiple trauma patients is critically important. It can be argued that the efficacy of ultrasonography (US) for detection of pneumothorax is enhanced if it is performed and interpreted directly by the clinician in charge of the patients. The aim of this study was to assess the ability of emergency department clinicians to perform bedside US to detect and assess the size of the pneumothorax in patients with multiple trauma. METHODS: Over a 14 month period, patients with multiple trauma treated in the emergency department were enrolled in this prospective study. Bedside US was performed by emergency department clinicians in charge of the patients. Portable supine chest radiography (CXR) and computed tomography (CT) were obtained within an interval of three hours. Using CT and chest drain as the gold standard, the diagnostic efficacy of US and CXR for the detection of pneumothorax, defined as rapidity and accuracy (sensitivity, specificity, positive predictive value, negative predictive value), were compared. The size of the pneumothorax (small, medium and large) determined by US was also compared to that determined by CT. RESULTS: Of 135 patients (injury severity score = 29.1 +/- 12.4) included in the study, 83 received mechanical ventilation. The time needed for diagnosis of pneumothorax was significantly shorter with US compared to CXR (2.3 +/- 2.9 versus 19.9 +/- 10.3 minutes, p < 0.001). CT and chest drain confirmed 29 cases of pneumothorax (21.5%). The diagnostic sensitivity, specificity, positive and negative predictive values and accuracy for US and radiography were 86.2% versus 27.6% (p < 0.001), 97.2% versus 100% (not significant), 89.3% versus 100% (not significant), 96.3% versus 83.5% (p = 0.002), and 94.8% versus 84.4% (p = 0.005), respectively. US was highly consistent with CT in determining the size of pneumothorax (Kappa = 0.669, p < 0.001). CONCLUSION: Bedside clinician-performed US provides a reliable tool and has the advantages of being simple and rapid and having higher sensitivity and accuracy compared to chest radiography for the detection of pneumothorax in patients with multiple trauma.

[The epidemiological study on human immunodeficiency virus infection among paid blood donors living in Shandong provincial China Comprehensive Response Project Areas].

OBJECTIVE: To understand the current epidemic situation and high risk factors of human immunodeficiency virus (HIV) infection among paid blood donors living in Shandong provincial China Comprehensive Response (CARES) Project Areas. METHODS: All residents between 20 to 60 years old were selected from one or several counties in August 2003. RESULTS: There were 19 HIV(+) infections among 661 subjects interviewed. HIV prevalence rate among paid blood donors was higher (3.98%) than that of others (0.48%) while HIV prevalence rate was higher in plasma donors (7.24%) than that in both plasma and full blood donors (2.90%). There was no infections identified in full blood donors. Donors who donated blood during 1994 - 1995 had a higher prevalence rate (7.07%) than those who started donation after 1995 and those began donation before 1993 (0.99%). The rate of condom use was lower among paid blood donors (13.72%) than that of others. There was a lower rate of voluntary HIV testing among paid blood donors than that of others. CONCLUSION: The main high risk population of HIV infection were paid donors in CARES Project Areas, whose risk factor was plasma donation and were infected mainly before 1995. Both the rate of condom use and HIV testing were all very low, indicating that they knew little on HIV/AIDS and paid less attention to self-proctection. It is necessary to enhance HIV/AIDS health education and behavior intervention on paid blood donors.

[Assessment of myocardial ischemia and infarction by intravenous myocardial contrast echocardiography with perfluorocarbon microbubbles]

OBJECTIVE: To assess the value of myocardial contrast echocardiography (MCE) with intermittent second harmonic technique and perfluorocarbon microbubbles in identifying myocardial ischemia and infarction. METHODS: Open-chest dogs were performed by intravenous MCE with perfluorocarbon microbubbles after 3 h of left anterior descending coronary artery (LAD) occlusion. The parameters of time-intensity curve were measured and compared between the normal and ischemic myocardial area at short-axis view of left ventricule midpapillary muscle level. The infarct size assessed by MCE was compared with the gross pathologic specimen stained with triphenyltetrazolium chloride (TTC). RESULTS: The peak intensity (PI), T1/2, and area under curve (AUC) in the ischemic area were significantly different versus the normal area 13.5+/-1.9 compared with 22.5+/-2.4; 16.6+/-0.9 compared with 9.7+/-0.5; 231.6+/-14.9 compared with 405.6+/-12.3 P<0.02). The percents of the no flow area determined by MCE had correlation with those by TTC stain(r=0.89, P=0.01). CONCLUSION: Intermittent second harmonic MCE using intravenous injection of perfluorocarbon microbubbles could assess myocardial perfusion, diagnose ischemia, and define myocardial infarct size.