Long-term prognostic value of Murray law-based quantitative flow ratio in jailed left circumflex coronary artery after left main crossover stenting.

We aimed to evaluate the impact of new Murray law-based QFR of jailed left circumflex coronary artery (LCx) on long-term clinical outcomes after left main coronary artery (LM) simple crossover stenting. 164 patients who underwent LM-to-left anterior descending coronary artery simple crossover stenting and had appropriate angiographic view of LCx for QFR computation were enrolled. The primary clinical outcome was the 5-year target lesion failure (TLF), defined as a composite of cardiac death, a target vessel myocardial infarction or target lesion repeat revascularization. The mean QFR of the LCx after LM stent implantation was 0.88 ± 0.09, and 29 patients (17.7%) had a low QFR (< 0.80), which was significantly associated with a higher 5-year rate of TLF when compared with the high QFR group (27.6% vs. 6.7%; HR: 4.235; 95% CI 1.21-14.95; p = 0.0015). The 5-year LCx ostium-related TLR rate in the low QFR group was also higher (17.2% vs. 3.0% in the high QFR group; HR: 6.07, 95% CI 1.63-22.59, p = 0.002). In a multivariate Cox regression analysis, a low QFR in the LCx after LM stenting was an independent predictor of the 5-year TLF rate (HR: 3.21, 95% CI 1.21-8.53; p = 0.019). ROC analysis showed that QFR a negative predictive value (NPV) of 89.6% ([AUC] 0.73, 95% CI 0.58-0.88, p < 0.05), the cutoff point is 0.85. The patients with a low QFR (< 0.80) in jailed LCX after LM simple crossover stenting had worse 5-year outcomes than those with a high QFR. Conversely, a QFR ≥ 0.85 of jailed LCx could serve as a good predictor of low risk of adverse outcome in LCx ostium. The QFR computation of the jailed LCx may be helpful to determine whether an additional procedure is required for the jailed side branch.

MicroRNA-9 rescues hyperglycemia-induced endothelial cell dysfunction and promotes arteriogenesis through downregulating Notch1 signaling.

Hyperglycemia-induced endothelial dysfunction plays a major role in the pathogenesis of diabetic vascular complications. MicroRNAs are potential therapeutic agents to improve hyperglycemia-induced endothelial dysfunction. This study examined the relationship of miR-9 with Notch1 signaling in hyperglycemia-induced endothelial dysfunction. Human umbilical vein endothelial cells (HUVECs) were exposed to 30 mM glucose concentration. Cell viability including proliferation, adhesion, migration and tube formation was significantly impaired. Quantitative real time polymerase chain reaction (qRT-PCR) or Western blot demonstrated that miR-9 expression remarkably decreased and expression of Notch1 and its effectors (Hes1, Hey1, Hey2) were upregulated. Transfection with miR-9 improved cell function, inhibited mRNA and protein expression of Notch1 and its effectors. Although basal expression of the arterial endothelium biomarker Ephrin B2 was almost undetectable in HUVECs, double-label immunofluorescence revealed that transfection with miR-9 upregulated Ephrin B2 expression. By contrast, such protective effects of miR-9 overexpression were eliminated due to use of miR-9 inhibitor. Dual luciferase assay further confirmed a significant inverse correlation between miR-9 and Notch1. In addition, Notch1 overactiviation was mimicked in HUVECs by transfecting with Notch1 intracellular domain (NICD1). MiR-9 significantly inhibited NICD1 mRNA expression and alleviated hyperglycemia-induced injury of the NICD1-overexpressing cells. Taken together, our data support upregulating miR-9 expression as a potential therapeutic strategy to antagonize hyperglycemia-induced injury by inhibiting Notch1 signaling.

Role of Diabetes Mellitus in Acute Coronary Syndrome Patients with Heart Failure and Midrange Ejection Fraction Who Have Undergone Percutaneous Coronary Intervention: A 3-Year Case-Series Follow-Up Retrospective Study.

BACKGROUND: Data are limited on the effect of diabetes mellitus (DM) on the prognosis of acute coronary syndrome (ACS) patients with heart failure with midrange ejection fraction (HFmrEF) who have undergone percutaneous coronary intervention (PCI). This study aimed to investigate the relationship between type 2 DM (T2DM) and 3-year outcomes in such a population. METHODS: A total of 377 ACS patients with HFmrEF (left ventricular EF 40%-49%) who had undergone PCI (132 diabetic and 245 nondiabetic patients) were included in the analysis. The primary outcome was a composite end point of all-cause death or HF rehospitalization. Cox proportional-hazard regression analysis and Kaplan-Meier tests were used to assess the effect of DM on the primary outcome. Sensitivity analysis was conducted with propensity score-matching analysis. RESULTS: During a follow-up of 3 years, diabetic patients had higher incidence of the primary outcome than nondiabetic patients (96.1 vs 44.6 per 1,000 patient-years, incidence ratio 2.301, 95% CI 1.334-3.969; P=0.002). Multivariate analysis showed that DM was associated with a significant increase in the composite outcome of all-cause death or HF rehospitalization (adjusted HR 2.080, 95% CI 1.115-3.878; P=0.021). Sensitivity analysis further confirmed that DM was an independent prognostic factor of long-term adverse outcomes for ACS patients with HFmrEF who had undergone PCI (adjusted HR 3.792, 95% CI 1.802-7.980; P<0.001). CONCLUSION: Among ACS patients with HFmrEF who had undergone PCI, T2DM comorbidity was significantly associated with worse long-term outcomes.

Relationship between components of metabolic syndrome and arterial stiffness in Chinese hypertensives.

Background: Subjects with metabolic syndrome showed increased risk of cardiovascular events. We investigated the relationship between components of metabolic syndrome and arterial stiffness in Chinese hypertensives.Method: 680 subjects (aged 58.44 ± 11.67 years, male 63.53%, hypertension 65.00%) were divided into five groups based on the number of known components of metabolic syndrome (MSCs) according to the criteria of 2010 Chinses Guidelines for Prevention and Management of Hypertension (0MSCs: n= 86; 1MSCs: n= 153; 2MSCs: n= 201; 3MSCs: n= 148; 4/5MSCs: n= 92.). Body weight, height, waist circumference, blood pressure and clinical biochemical tests were measured. Carotid-femoral pulse wave velocity (cfPWV) was measured using a non-invasive automatic device (Complior Analysis, France).Results: The level of cfPWV was significantly increased with the increasing number of MSCs (8.20 ± 1.54 vs 8.72 ± 1.48 vs 9.34 ± 1.77 vs 9.64 ± 1.86 vs 9.91 ± 2.19 m/s, P<0.05). In subjects with hypertension (n= 442), cfPWV was higher than those without hypertension (n= 238) (9.59 ± 1.90 vs 8.49 ± 1.50 m/s, P<0.05) . Stepwise multiple regression analysis revealed that age, gender, the number of MSCs, heart rate as well as serum uric acid level were determinants for cfPWV (P<0.05). In the subgroups stratified by age, systolic blood pressure correlated with cfPWV in hypertensives under 55 years old, while in non-hypertensives the correlation was found after 60 years old.Conclusion: The arterial stiffness became significant with the increasing of the metabolic components numbers, which was independent of age, gender and blood pressure. And the presence of hypertension played the most important role in the progress of arterial stiffness even compared with age.