Elevated serum FGF21 levels predict heart failure during hospitalization of STEMI patients after emergency percutaneous coronary intervention.

Background: Fibroblast growth factor 21 (FGF21) has multiple cardioprotective effects including modulation of glucolipid metabolism, anti-inflammation, and anti-oxidative stress, but its association with the heart failure during hospitalization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) has not been reported. Methods: A total of 348 STEMI patients treated with emergency PCI were included from January 2016 to December 2018. Relevant biochemical indicators were measured by central laboratory. Serum FGF21 levels were measured by ELISA. The occurrence of heart failure during hospitalization was recorded. Patients' cardiac function was assessed by echocardiography. Results: Serum FGF21 levels were significantly higher in the STEMI group with heart failure than in the group without heart failure (249.95 ± 25.52 vs. 209.98 ± 36.35, P < 0.001). Serum FGF21 levels showed a strong positive correlation with N-terminal precursor B-type natriuretic peptide (NT-proBNP) in STEMI patients (r = 0.749, P < 0.001). FGF21 was found to be an independent risk factor for the development of heart failure during hospitalization in STEMI patients by binary logistic regression analysis. The area under curve (AUC) for FGF21 to predict the development of heart failure during hospitalization in STEMI patients was 0.816 (95% CI [0.770-0.863]) according to the receiver operating characteristic (ROC) curve analysis. Conclusion: Elevated serum FGF21 levels have been shown to be a strong predictor of heart failure during hospitalization in patients with STEMI after emergency PCI.

Over-expression of cyclooxygenase-2 in increased reticulated platelets leads to aspirin resistance after elective off-pump coronary artery bypass surgery.

INTRODUCTION: Aspirin resistance (AR) has been reported to present after coronary artery bypass graft causing saphenous vein graft failure. We aimed to investigate the factors that affect the anti-platelet effect of aspirin after off-pump coronary artery bypass surgery (OPCAB). MATERIALS AND METHODS: Thirty OPCAB candidates were successively recruited. Platelet count, platelet aggregation, reticulated platelet (RP), platelets' cyclooxygenase (COX)-1 and COX-2 expressions were determined during the peri-operative period. Besides, 10 healthy volunteers were enrolled to determine the onset of the anti-platelet effect of aspirin as comparison. RESULTS AND CONCLUSIONS: The arachidonic acid-induced platelet aggregation (PLAA) decreased to <20% within 8h after taking 100mg aspirin in healthy volunteers. However, in the OPCAB patients, PLAA levels remained over 20% in 16 (53.3%) patients after resuming aspirin for 24h. The surgical bleeding volumes were higher in the AR patients compared to the normal responders (512.5±192.8 vs. 314.3±94.9, p=0.002). The platelet count on Day 8, RP proportions on Days 1, 4, 8, and COX-2 level on Day 4 were significantly increased compared to their baseline levels in AR group but not in AS group. Platelet count on Day 8, RP proportion and COX-2 on Day 4 were all significantly higher in AR group than those in AS group. The surgical bleeding volume and COX-2 over-expression were predictors of post-OPCAB AR. As a conclusion, the inability of aspirin to inhibit the COX-2 created by increased RP would account for the post-OPCAB AR.

Cardiac-specific expression of the hepatocyte growth factor (HGF) under the control of a TnIc promoter confers a heart protective effect after myocardial infarction (MI).

OBJECTIVE: Uncontrolled therapeutic gene expression and neovascularization in non-specific tissues has lowered the safety of gene therapy. The aim of the study was to identify a cardiac-specific promoter to control target gene expression in heart tissue in vitro and in vivo. METHODS: Adenovirus vectors containing the firefly luciferase or hepatocyte growth factor (HGF) genes under control of the Troponin I (TnIc) or Cytomegalievirus (CMV) promoters were transfected into cell lines or injected into the left ventricular wall of Sprague Dawley (SD) rats via thoracotomy. Myocardial infarction (MI) was induced immediately before direct injection. In vivo luciferase expression was assessed using a bioluminescence imaging system. Heart function was monitored via echocardiograph intermittently for eight weeks after injection. RESULTS: The constitutively active CMV promoter yielded luciferase expression throughout the body while luciferase expression driven by the TnIc promoter was largely restricted to the hypoxic heart. The CMV promoter was more efficient, yielding 100-1000 fold more light output than the TnIc promoter. Four weeks after injection, we observed a significant decline in the ejection fraction (EF) in saline and Ad-Null groups but a 17% increase in the Ad-CMV-HGF group. No change in EF was observed in the Ad-TnIc-HGF group. CONCLUSIONS: The adenovirus vector combined with the TnIc promoter largely restricts gene-targeted therapy in the hypoxic heart and prevents heart failure after myocardial infarction.

Evidence-based study on antithrombotic therapy in patients at risk of a stroke with paroxysmal atrial fibrillation.

The aim of the present study was to determine the optimal intensity of anticoagulation therapy in elderly patients with paroxysmal atrial fibrillation (PAF), using aspirin and varied concentrations of warfarin. Elderly patients with PAF (n=1,162) who met the inclusion criteria of the study and were at middle or high-risk of a stroke were investigated. Patients were divided into six groups (four high-risk groups and two middle-risk groups). Patients were treated with aspirin or varied concentrations of warfarin. The primary endpoint events, secondary endpoint events, major bleeding events and minor bleeding events were observed and compared. In high-risk elderly patients, warfarin significantly reduced primary and secondary endpoint events, total primary events and total events compared with aspirin. In middle-risk elderly patients, for all the events warfarin demonstrated no significant difference compared with aspirin. In high-risk patients with PAF, when the concentration of warfarin was adjusted to target international normalized ratio (INR) range 1.7-2.5, the primary and secondary endpoint events, total primary events and total events were significantly lower (P<0.05), compared with aspirin and warfarin at INR 1.2-1.6. When the intensity of warfarin was adjusted to the target INR 2.6-3.0, the primary and secondary endpoint events were significantly lower (P<0.05) compared with aspirin and warfarin INR at 1.2-1.6. This study determined that in high-risk elderly patients with PAF, warfarin is recommended for anticoagulation with an optimal INR range of 1.7-2.5. In patients at a middle-risk of a stroke, aspirin is the recommended treatment as an antithrombotic as results have indicated that there is limited benefit in the use of warfarin.

Magnetic navigation system and CT roadmap-assisted percutaneous coronary intervention: a comparison to the conventional approach.

BACKGROUND: Computed tomography coronary angiography (CTCA) has been successfully integrated with the magnetic navigation system (MNS) to facilitate a roadmap-assisted percutaneous coronary intervention (PCI). The aim of this study was to compare this new approach of PCI versus conventional PCI regarding the difference of contrast usage, x-ray exposure, procedure success, and in-hospital expenses. METHODS: Thirty-eight patients with stable coronary artery disease and coronary artery lesions of ≥70% diameter stenosis diagnosed by both pre-procedure CTCA and coronary angiography (CAG) were enrolled to receive the MNS and CT roadmap-assisted PCI. Another 38 patients were consecutively recruited to receive conventional PCI, matched with the MNS group by the vessel and lesion type base on American College of Cardiology/American Heart Association criteria. RESULTS: Regarding the process of the guidewire placement, wherein the technical difference of the two procedures exists, the median contrast usage for guidewire crossing was significantly lower in the MNS group than in the conventional group [0.0 mL (interquartile range [IQR], 0.0-3.0 mL) vs 5.0 mL (IQR, 3.1-6.8 mL); P<.001], with zero contrast usage in 25 of the 44 guidewire placements in the MNS group, but in none of the conventional group; the radiation dosage for guidewire crossing in the MNS group was also significantly lower than in the conventional group (235.8 µGym² [IQR, 134.9-455.1 µGym²] vs 364.4 µGym² [IQR, 223.4-547.2 µGym²]; P=.033). There were no significant differences between the two groups concerning the total contrast usage, total radiation dosage of the PCI, the procedural fees, or the overall in-hospital expenses. All of the enrolled vessels were successfully intervened in both groups. CONCLUSION: In PCI of simple lesions, the application of CT guidance and magnetic navigation had modest impacts on radiation dosage and contrast usage for wire crossing, but no impact on overall radiation dosage or contrast usage for the procedure. In addition, the use of CT roadmap and MNS was likely more expensive compared to PCI using conventional radiographic technique.

[A study on the association of obstructive sleep apnea hypopnea syndrome with coronary atherosclerosis and coronary heart disease].

OBJECTIVE: To investigate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) with coronary atherosclerotic disease (CAD). METHODS: From March of 2005 to December of 2005, 82 subjects admitted into Department of Cardiology of The First Affiliated Hospital of Nanjing Medical University were recruited. They were divided into three groups based on their nocturnal apnea hypopnea index (AHI) detected by examination of polysomnography (PSG): mild OSAHS group (5 < AHI < or = 20, 38 cases), moderate-to-severe group (AHI > 20, 20 cases) and control group (AHI < 5, 24 cases). Coronary artery angiography and Gensini Score for assessing the severity of coronary atherosclerosis were performed in all three groups. RESULTS: Compared with the control group, the apnea-hypopnea index (AHI) was significantly higher in OSAHS groups [10.9 (7.7 - 15.2), 29.3 (23.3 - 48.4) vs 2.9 (1.9 - 3.8)]. The minimal SpO(2) was significantly lower (84 +/- 9)%, (81 +/- 9)% in OSAHS groups than that in the control group (89 +/- 6)%. The incidence of CAD was significantly higher [66% (25/38) and 95% (19/20)] in OSAHS groups than in the control group [17% (4/24)]. The percentage of patients with single-coronary-vessel disease was 24% (9/38) in mild OSAHS group, 20% (4/20) in moderate-to-severe OSAHS group, and 17% (4/24) in control group. The patients with multi-coronary-vessel disease were 42% (16/38) in mild OSAHS group, 80% (16/20) in moderate-to-severe OSAHS group, and 12.5% (3/24) in control group. Gensini Score was significantly higher in moderate-to-severe OSAHS group than that in control group [35.0 (16.5 - 87.0), 1.0 (0.0 - 5.0)]. Moreover, a positive correlation was revealed between AHI and Gensini Score. CONCLUSION: OSAHS may be a significant independent risk factor of coronary atherosclerosis and CAD and should be taken into account in CAD secondary prevention.