International heart journal最新文献

The aim of this study was to explore the association between angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism in the 16th intron and the occurrence of left ventricular hypertrophy (LVH) in hypertensive individuals.This study included 269 patients with hypertension from Dushu Lake Hospital Affiliated to Soochow University who underwent echocardiographic examinations. Among them, 55 patients had hypertension combined with LVH, while 214 patients with hypertension did not have LVH, serving as the case and control groups, respectively. Polymerase chain reaction-restriction fragment length polymorphism was used to perform genetic testing for hypertension in all 269 patients. The Hardy-Weinberg equilibrium test was used to assess genetic equilibrium. The differences in genotype frequencies between the case and control groups were analyzed using the chi-square test. All statistical analyses were performed using SPSS software (version 27.0.1), with statistical significance set at P < 0.05.Genotype distribution in the case and control groups conformed to the Hardy-Weinberg equilibrium (P > 0.05). There was a significant difference in genotype distribution between the case and control groups.Conclusion: ACE gene polymorphism is associated with an increased risk of hypertension combined with LVH.

Atherosclerosis (ATH) represents a major cause of cardiovascular disease. Long noncoding RNA (LncRNA) myocardin-induced smooth muscle lncRNA, inducer of differentiation (MYOSLID) and microRNA (miR) -29c-3p show substantial roles in ATH. We investigated their regulatory mechanisms on vascular smooth muscle cell (VSMC) proliferation and migration.Angiotensin (Ang) II-induced VSMCs were used for in vitro research. The MYOSLID and miR-29c-3p expression patterns in VSMCs were assessed by reverse transcription-quantitative polymerase chain reaction. MYOSLID was overexpressed, or miR-29c-3p was silenced in VSMCs by cell transfection, followed by proliferation, migration, and apoptosis evaluation. The colocalization of MYOSLID and miR-29c-3p was observed by RNA in situ hybridization. The targeted binding relationship of miR-29c-3p and MYOSLID was verified by dual-luciferase and RNA immunoprecipitation assays. Joint experiments were performed with the overexpressed MYOSLID and miR-29c-3p via cotransfection. An ATH mouse model was established and injected with LV-MYOSLID, with the aortic root atherosclerotic lesion observed by HE staining and the α-SMA expression determined by immunohistochemistry.The MYOSLID expression was decreased, while the miR-29c-3p expression was increased in the Ang II-induced VSMCs, along with the promoted VSMC proliferation, apoptosis, and migration. Meanwhile, the MYOSLID overexpression or miR-29c-3p silencing repressed the Ang II-induced VSMC behaviors. The miR-29c-3p mimics reduced the luciferase activity of the MYOSLID 3'UTR-WT-transfected cells, but had no obvious influence on the MYOSLID 3'UTR-MUT-transfected cells. Overexpressed miR-29c-3p partially nullified the highly expressed MYOSLID-repressed Ang II-induced VSMC apoptosis, proliferation, and migration. The MYOSLID overexpression repressed the miR-29c-3p expression and reduced the atherosclerotic lesion area and the number of α-SMA-positive VSMCs in ATH mice.The MYOSLID overexpression restrained the Ang II-induced VSMC proliferation, migration, and apoptosis by repressing the miR-29c-3p expression, thus retarding the atherosclerotic plaque formation.

There is growing evidence that body nutritional status influences the development of cardiovascular disease, particularly in the elderly population. The Geriatric Nutritional Risk Index (GNRI), as a tool for assessing the nutritional status and nutritional risk of elderly individuals, is applied in clinical practice. This study aimed to elucidate the relationship between GNRI and cardiovascular disease in the elderly and to assess the impact of nutritional status on cardiovascular disease.This study is a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) database. The data for this investigation were obtained from the NHANES database from 2007 to 2018, which included 10,277 individuals aged 60 years and older. The relationship between GNRI and cardiovascular disease in the elderly was investigated using weighted multivariable logistic regression models, and smooth fitting curves were drawn to explore their association. In addition, subgroup analyses were used to explore population differences.In this study, after adjusting for all confounding variables, the odds ratio and 95% confidence intervals (CI) of the model were 0.98 (0.96, 1.00), with no statistically significant association. Smooth fitting curves showed a nonlinear correlation between GNRI and cardiovascular disease. We found an inflection point (GNRI = 139.55). Moreover, GNRI was negatively associated with cardiovascular disease in the elderly before the inflection point and not statistically significant after the inflection point.In this large cross-sectional study, we found a nonlinear correlation between GNRI and cardiovascular disease in the general elderly population in the United States.

Rotablator-associated coronary perforation can be fatal if bailout is delayed. Successful bailout is typically defined as the disappearance of contrast extravasation after a haemostatic intervention. We report a case of recurrent cardiac tamponade in the subacute phase, wherein haemostasis appeared to have been achieved on angiography following the implantation of a covered stent during the index procedure.A 61-year-old male underwent a percutaneous coronary intervention with a rotator placed in the middle of the left ascending artery. Coronary perforation occurred during rotablation and was treated with a covered stent. However, cardiac tamponade recurred on postoperative day 30. Emergency coronary angiography was performed, and no contrast extravasation was observed on angiography. However, intravascular ultrasonography was performed to clarify the cause of the recurrent pericardial effusion and revealed that the distal edge of the covered stent was not fully attached to the vessel wall due to protruding calcification. Another covered stent was placed distal to the previous stent for sealing the malapposed site. There was no recurrence of pericardial effusion.Malapposition of covered stents may not be detected by angiography alone, potentially resulting in recurrent bleeding. Intravascular imaging is an effective tool to confirm adequate stent apposition.

Trunk muscle decrease is reportedly associated with an increased risk of multiple adverse clinical outcomes. Acute aortic dissection (AAD) involves a systemic inflammatory response which is associated with exaggerated muscle protein catabolism. AAD requires prolonged hospitalization and potentially exacerbates muscle size decrease.Cross-sectional areas (CSA) of both the bilateral psoas muscle area (PMA) and L4 vertebral body were determined using CT scans on admission to calculate the psoas-lumbar vertebral index (PLVI = bilateral PMA/L4 body CSA) in 141 hospitalized type B AAD patients. Serial CT scans within 30 days were performed to investigate PLVI change (%/day) calculated as: (PLVI at follow-up - PLVI at admission) /PLVI at admission × 100/follow-up interval (days). Patients were categorized into a large decrease of PLVI (LD) group and a modest decrease and increase of PLVI (MDI) group according to the median value of decreased PLVI change (-0.48%/day).A large PLVI decrease was correlated with a higher peak C-reactive protein (CRP) value (13.8 versus 10.9 mg/dL, P = 0.010), and larger false lumen (FL) diameter (13.6 versus 11.4 mm, P = 0.015). The days until ambulation and the length of hospital stay were slightly longer in the LD group than in the MDI group (days until ambulation, P = 0.111; length of hospital stay, P = 0.053). Logistic regression model analysis demonstrated a higher peak CRP level (OR = 3.43; 95% CI, 1.50-7.84) and larger %FL diameter (OR = 3.88; 95% CI, 1.55-9.69) were predictive of a large PLVI decrease.Our results indicate that a larger FL and subsequent exaggerated inflammatory response may result in a trunk muscle decrease in type B AAD patients.

Rheumatic heart disease remains common in developing countries. Current guidelines recommend percutaneous mitral commissurotomy (PTMC) as the preferred treatment for patients with rheumatic mitral stenosis (MS). This study reports the clinical outcomes of PTMC for rheumatic MS in contemporary Chinese patients and analyzes prognostic factors.Data from patients who underwent PTMC at our center between January 2007 and July 2023 were retrospectively analyzed. The primary outcome was the composite of all-cause death, repeated PTMC, and mitral valve surgery. Survival curve was constructed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify prognostic predictors, and hazards ratio (HRs) with 95% confidence intervals (CIs) were reported.A total of 262 patients with a mean age of 50.1 ± 14.1 years were included. The median follow-up time was 69.5 months. Kaplan-Meier analysis showed that primary outcome-free survival rate was 85.6% ± 2.5%, 67.2% ± 4.2%, and 55.2% ± 6.5% at 5, 10, and 15 years, respectively. In multivariate Cox regression analysis, preprocedural transmitral E peak velocity (Emax) (HR = 1.009, 95% CI: 1.002-1.016, P = 0.015), postprocedural mitral valve orifice area (MVOA) (HR = 0.284, 95% CI: 0.108-0.746, P = 0.011), and postprocedural mitral regurgitation (MR) ≥ 2+ (HR = 2.710, 95% CI: 1.382-5.314, P = 0.004) were identified as the independent predictors of the primary outcome.The clinical outcomes of PTMC are favorable for suitable patients with rheumatic MS. Meanwhile, preprocedural Emax, postprocedural MVOA, and postprocedural MR ≥ 2+ are the prognostic factors.

Ticagrelor, an effective antiplatelet for acute coronary syndrome (ACS), may elevate serum uric acid (SUA), potentially causing gout. This study aims to identify risk factors for ticagrelor-induced in-hospital gout in patients with ACS and create a predictive model for clinical use.A total of 1164 patients with ACS treated with ticagrelor (n = 640) or clopidogrel (n = 524) were retrospectively analyzed. The incidence of in-hospital gout and changes in SUA levels were compared between the groups. Patients with ticagrelor were further divided into gout and non-gout groups to identify risk factors using logistic regression. A nomogram model was constructed based on significant risk factors.The incidence of in-hospital gout was significantly higher in patients with ticagrelor than in patients with clopidogrel (9.8% versus 1.9%, P < 0.001). There were significant differences in SUA levels between the groups. Logistic regression revealed alcohol consumption, total cholesterol, and baseline SUA as independent risk factors for gout. A nomogram model was developed and demonstrated good predictive accuracy.Ticagrelor was associated with a higher risk of in-hospital gout than clopidogrel in patients with ACS. Alcohol use, total cholesterol, and baseline uric acid are key risk factors. The nomogram model developed in this study can assist in predicting the risk of in-hospital gout in patients with ACS treated with ticagrelor.

Current classifications of chronic limb-threatening ischemia (CLTI) are insufficient to identify Rutherford (R) 4 patients with a poor prognosis. This study aimed to investigate the prognostic factors for patients with R4 CLTI who undergo endovascular treatment (EVT) using data from the Tokyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry and to propose a risk-scoring system. We analyzed the data of 2,248 prospectively enrolled patients from the registry, divided into 3 groups: intermittent claudication (IC), n = 1,185; R4, n = 401; and R5-6, n = 662. We ascertained amputation-free survival (AFS) 1, 6, 12, 18, and 24 months post-EVT. The 2-year major AFS rates for IC, R4, and R5-6 were 0.944 (95% confidence interval [CI]: 0.921-0.960), 0.830 (0.753-0.885), and 0.576 (0.508-0.638), respectively. The final logistic regression model after addressing optimism included 5 factors: Non-ambulatory status, White blood cell count ≥ 10,000/μL, Revascularization for lesions in the infrapopliteal arteries, previous history of Cerebrovascular disease, and New York Heart Association class III-IV Heart failure (NoWRiCH score). We developed 3 risk-scoring models. When non-ambulatory status was assigned 2 points and the other factors were assigned 1 point each, the prognosis of R4 patients with ≥ 2 points was equivalent to that of R5-6 patients (R4/R5-6; 2-year survival rate, 95% CI: 0.423, 0.204-0.628, P < 0.001/0.576, 0.508-0.638, P < 0.001). The NoWRiCH score facilitates the identification of R4 patients with a poor prognosis.

By ambulatory blood pressure monitoring (ABPM), nocturnal blood pressure (BP) may increase before heart rate (HR), but the details are unknown.Among 102 participants who underwent ABPM, > 90% on hypertension treatment, the averaged BP (HR) data were examined for the time at which the BP (HR) increased significantly above the mean midnight BP (HR) between 3:00 AM - 9:00 AM in all patients and in subgroups divided by clinical variables. Participants were also divided according to the respiratory sinus arrhythmia (RSA) index, which is the ratio of the longest and shortest RR intervals obtained under normal breathing, and the effects of RSA on the nocturnal hemodynamics were examined.The average age of the patients was 70 ± 11 years, and there were 47 (46.1%) males. After midnight, the BP increased and was significantly greater than the midnight BP at 5:00 AM. The time of significant increase in BP was affected by clinical variables and the RSA index; an RSA index < 5% (> 10%) was associated with the earliest (latest) time of BP increase. However, the HR remained unchanged until 7:00 AM or later. According to the ABPM data, a discordant time course between BP and HR and the effect of RSA were evident during the nocturnal period.BP increased earlier than HR toward dawn, and this phenomenon was affected by clinical variables. A low RSA index facilitated the onset of BP increase. The underlying mechanisms and clinical significance of the role of RSA in circulatory regulation remain to be investigated.

Cardiac rehabilitation (CR) improves physical function in patients with acute decompensated heart failure (ADHF) and frailty. However, few studies have assessed physical function through multiple measures during hospitalization; moreover, the effect of age remains unclear. This study aimed to evaluate age-specific changes in physical function during the acute-phase treatment period in patients with ADHF. Patients with ADHF hospitalized between June 2018 and June 2023, who were aged ≥ 60 years and underwent CR, were included in the study. Physical function assessments at admission and discharge included grip strength, quadriceps isometric strength, short physical performance battery (SPPB), gait speed, and frailty. Changes in physical function from admission to discharge were assessed. The mean age of the 531 patients was 79.8 ± 9.0 years and 58% were male. Physical function at admission and discharge significantly decreased with age according to all measures. In patients aged ≥ 90 years, quadriceps isometric strength (0.27 ± 0.11 kgf/BW kg) and the SPPB score (4.5 ± 3.6 points) were severely impaired at admission. However, no significant differences were observed in changes in physical function according to age; the improvement in the SPPB score tended to increase with age (+1.7 ± 1.9, +2.3 ± 2.1, +2.2 ± 2.4, and +2.3 ± 1.8, in the 60-69-, 70-79-, 80-89-, and ≥ 90-year age groups, respectively). The improvement in frailty was similar in all groups. Although physical function declined with age, the changes in physical function were similar in patients with ADHF at any age above 60 years who underwent CR.