Neuregulin-1 promotes mitochondrial biogenesis, attenuates mitochondrial dysfunction, and prevents hypoxia/reoxygenation injury in neonatal cardiomyocytes.

Neuregulin-1 (NRG-1)/erythroblastic leukaemia viral oncogene homologues (ErbB) pathway activation plays a crucial role in regulating the adaptation of the adult heart to physiological and pathological stress. In the present study, we investigate the effect of recombined human NRG-1 (rhNRG-1) on mitochondrial biogenesis, mitochondrial function, and cell survival in neonatal rat cardiac myocytes (NRCMs) exposed to hypoxia/reoxygenation (H/R). The results of this study showed that, in the H/R-exposed NRCMs, mitochondrial biogenesis was impaired, as manifested by the decrease of the expression of peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) and mitochondrial membrane proteins, the inner membrane (Tim23), mitofusin 1 (Mfn1), and mitofusin 2 (Mfn2). RhNRG-1 pretreatment effectively restored the expression of PGC-1α and these membrane proteins, upregulated the expression of the anti-apoptosis proteins Bcl-2 and Bcl-xL, preserved the mitochondrial membrane potential, and attenuated H/R-induced cell apoptosis. Blocking PGC-1 expression with siRNA abolished the beneficial role of rhNRG-1 on mitochondrial function and cell survival. The results of the present study strongly suggest that NRG-1/ErbB activation enhances the adaption of cardiomyocytes to H/R injury via promoted mitochondrial biogenesis and improved mitochondrial homeostasis. SIGNIFICANCE OF THE STUDY: The results of this research revealed for the first time the relationship between neuregulin-1 (NRG-1)/erythroblastic leukaemia viral oncogene homologues (ErbB) activation and mitochondrial biogenesis in neonatal cardiomyocytes and verified the significance of this promoted mitochondrial biogenesis in attenuating hypoxia/reoxygenation injury. This finding may open a new field to further understand the biological role of NRG-1/ErbB signalling pathway in cardiomyocyte.

[Impact of anemia on long-term outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary interventions].

OBJECTIVE: To assess the impact of pre-procedure anemia on the long-term mortality in elderly patients with acute coronary syndrome (ACS) after percutaneous coronary interventions. METHODS: A total of 1014 ACS patients (≥ 60 years of age) with hemoglobin data and without previous treatment with thrombolytic agents and without end-stage renal failure before the interventional procedure were included. Patients were classified as anemia using the definition of World Health Organization: hemoglobin < 130 g/L in men, and < 120 g/L in women. A total of 253 patients were anemia. The clinical features of patients with and without anemia and association of pre-procedure anemia with long-term mortality were analyzed. RESULTS: Incidence of diabetes and serum creatinine level were significantly higher in anemia patients than in non-anemia patients while systolic blood pressure and low-density lipoprotein cholesterol were significantly lower in anemia patients than in non-anemia patients (P < 0.05 or P < 0.01). The patients were followed up for 528 (178 - 675) days. After adjustment for potential co-variants in Cox regression analysis, pre-procedure anemia was associated with a significantly higher long-term mortality (RR: 3.293, 95%CI: 1.431 - 7.578, P < 0.01). CONCLUSION: Pre-procedure anemia is an independent predictor of long-term mortality in elderly patients with acute coronary syndrome after percutaneous coronary interventions.

[Optimal pharmacotherapy according to guideline improved prognosis of outpatients with chronic heart failure].

OBJECTIVE: To evaluate the effects of optimal pharmacotherapy according to guideline on treating chronic heart failure(CHF) in real world clinical practice. METHODS: A total of 231 consecutive outpatients with reduced left ventricular ejection fraction (LVEF ≤ 40%) and enlarged left ventricular end diastolic diameter (male > 55 mm, female > 60 mm) were recruited from January 2001 to June 2009. All patients were treated with optimal pharmacotherapy according to guideline recommendations and followed up to December 31, 2009. Mortality, rehospitalization and changes of heart size and cardiac function at baseline and at the end of follow-up period were analyzed. RESULTS: (1) 14 patients were lost during follow-up (6.1%), and follow-up was complete in 217 patients (93.9%). 97.2% and 98.2% patients were prescribed angiotensin converting enzyme (ACE) inhibitors and ß-blockers (ßB). Combined of ACE inhibitors and BB use was applied in 95.3% patients. The target dose of ACE inhibitors and ßB were reached in 50.7% and 37.3% patients. (2) Lower mortality and re-hospitalization rates were observed in this cohort: all-cause morality, average annual mortality was 11.5% and 3.9% respectively. Re-hospitalization rate was 27.6%. (3) Left ventricular end-diastolic diameter (LVEDD) decreased from (68.2 ± 7.2) mm to (62.2 ± 9.6) mm. LVEDD value was normal or near normal (male ≤ 60 mm, female ≤ 55 mm) in 43.2% patients. LVEF improved form (29.8 ± 7.5)% to (43.3 ± 11.8)%, LVEF was > 40% in 60.4% patients, LVEF was ≤ 40% but increased ≥ 10% after treatment in 22.9% patients. CONCLUSION: Optimal pharmacotherapy according to guideline can improve prognosis of outpatients with CHF.

[Impact of overweight on clinical outcomes in patients undergoing coronary revascularization].

OBJECTIVES: To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization. METHODS: The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1, 2004 and September 30, 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI < 24; overweight group, BMI 24-27.9; obesity group, BMI > or = 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups. RESULTS: 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59.3 +/- 10.14 years, 58.6 +/- 10.30 years vs 62.6 +/- 9.93 years, P < 0.01) and had a significantly higher incidence of hypertension (61.2, 66.8% vs 52.5%, P = 0.017), stable angina pectoris (21.2%, 23.7% vs 17.0%, P = 0.05) and higher triglyceride [(1.90 +/- 1.05) mmol/L, (2.10 +/- 1.12) mmol/L vs (1.48 +/- 0.92) mmol/L, P < 0.01)], fasting blood glucose level [(6.07 +/- 2.09) mmol/L, (5.96 +/- 1.53) mmol/L vs (5.67 +/- 1.92) mmol/L, P = 0.021), blood creatinine (84.9 +/- 21.7) micromol/L, (90.2 +/- 30.9) micromol/L vs (82.2 +/- 25.8) micromol/L, P = 0.002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0.285, 95%CI 0.104 - 0.777) and MACCE (0.596, 95%CI 0.401 - 0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95%CI 0.442 - 1.338) and MACCE (0.998, 95%CI 0.754 - 1.322), there was hardly any significantly difference in cardiac mortality between three groups (P = 0.223). CONCLUSION: There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.

[An analysis of the prognostic factors of acute myocardial infarction in different gender].

OBJECTIVE: To analyse the prognostic factors of ST-elevation acute myocardial infarction men and women. METHODS: The data of 904 in-hospital patients with ST-elevation myocardial infarction were collected from the database of our hospital during 2003 - 2004 and 728 of them were followed-up. The patients were divided into groups of male and female. RESULTS: Women had more accompanying diseases such as diabetes mellitus (DM) and hypertension than men; left ventricular ejection fraction (LVEF) was lower in female. The rate of successful reperfusion was lower in women than men (P < 0.05). Mortality rate was higher in women. 728 (202 female) patients were followed up. The use of beta-blockers were statistically different between two groups during follow-up. In the female group, LVEF was lower significantly and the rate of readmission for heart failure and myocardial infarction as well as that of mortality was higher (P < 0.05). Multivariate analysis showed that sex difference was an independent risk factor for in-hospital mortality (OR = 2.130, 95% CI 0.954 - 4.754, P = 0.045), but not for mortality in the followed-up period and readmission. CONCLUSION: There are many factors leading to the poor prognosis of ST-elevation acute myocardial infarction in women. It is essential to pay more attention to its clinical characteristics and begin intervention of the risk factors earlier so as to improve the prognosis.

[Cardiac manifestations of Fabry's disease].

OBJECTIVE: Fabry' s disease is a rare X-linked recessive disease. Its cardiac manifestations are not well recognized. METHODS: The data of 3 patients from different Chinese kindreds with Fabry's disease and cardiac manifestations who seeked medical advice in our department in 2007 were analyzed. The age, sex, family history, main symptoms, ECG and echocardiographic findings were recorded for all the patients. The diagnostic criteria of Fabry's disease was based on alpha-galactosidase (alpha-GAL) quantity in white blood cells. RESULTS: All of the patients were female. Their age was from 41 to 57. Two of them had the typical symptoms of Fabry's disease in their young age. All of them had family history of the disease and cardiac symptoms. ECG showed ST-T change and echocardiography showed hypertrophy of left ventricule of different degrees. Their alpha-galactosidase level in white blood cells was lower than normal. The alpha-galactosidase level in patient 1 was the lowest. Her cardiac symptoms were most serious in the three patients and she had involvement of other organs. CONCLUSION: Patients with Fabry's disease may have cardiac manifestations. Family history, typical symptoms in young age and the characteristics of multisystemic disorder are helpful clues to the diagnosis.

[Effects of chronic renal insufficiency and anemia upon long-term outcomes in patients undergoing percutaneous coronary intervention].

OBJECTIVE: To assess whether chronic renal insufficiency and anemia are significant independent and combined predictors of poor long-term outcomes after percutaneous coronary intervention (PCI). METHODS: We examined the clinical and outcome data of 3770 PCI patients based on the pre-PCI values of glomerular filtration rate (GFR) and hemoglobin (Hb). Depending on their baseline GFR and Hb, the patients were classified into six groups: normal renal function with anemia or not; mild renal impairment with combined anemia or not; severe renal insufficiency with anemia or not. The clinical features and prognosis of patients were compared. RESULTS: Significant differences were found between the groups regarding female gender, age, body mass index, prior history of hypertension, diabetes mellitus, prior stroke, acute coronary syndrome, systolic blood pressure, left ventricular ejection fraction, total serum cholesterol, LDL-C and angiographic features (P < 0. 01). When evaluated as continuous variables, GFR and Hb were independent predictors of long-term mortality after adjusting for effects of each other (GFR: HR 0.979, 95% CI 0.960-0.999, P = 0.035; Hemoglobin: HR 0.952, 95% CI 0.921-0.984, P = 0.004). Mild renal insufficiency with anemia (HR 4.123, 95% CI 1.637-10.386, P = 0.003), severe renal insufficiency without anemia (HR 5.287, 95% CI 1.627-17.183, P = 0. 006) and severe renal insufficiency with anemia (HR 7.134, 95% CI 2.180-23.342, P = 0.001) having a statistically significant decrease in survival in patients undergoing PCI . CONCLUSION: Renal insufficiency and anemia are significant independent and combined predictors of long-term mortality in patients undergoing PCI.

[Serum troponin I level in patients with hypertrophic cardiomyopathy].

OBJECTIVE: To observe serum troponin I (TNI) level in patients with hypertrophic cardiomyopathy (HCM). METHOD: Six hundreds and twelve HCM patients were analyzed prospectively from January 1990 to November 2007.Ultracardiography were detected for all the patients. The diagnostic criteria of HCM is ventricular wall thickness more than 15 mm. Serum TNI level was measured in 116 patients with HCM. Clinical data including age, gender, history, main symptoms, NYHA grade, coronary angiograph, electrocardiogram and echocardiography were compared between patients with normal and increased TNI levels. RESULTS: In 116 patients who detected TNI, 62 of them (53.4%) had a degree higher than normal. The median TNI value of all these patients is 0.07 ng/ml (0 - 4.38 ng/ml). Sixty-nine patients (59.5%) had undergone coronary angiography. Only 9 of them (13.0%) could be diagnosised as coronary heart disease. The TNI values of HCM patients with or without coronary heart disease were similar. The factors related to a higher TNI value included maximal depth of ventricule (P < 0.05), significant T inversion (P < 0.01) and chest pain (P < 0.05). Compared to all the 612 patients, the ones who detected serum TNI were likely to have chest pain (45.7% vs. 34.5%, P < 0.01) and significant T inversion (75.9% vs. 30.1%, P < 0.01). CONCLUSION: Increased serum TNI could be seen in half of HCM patients, especially in those patients with chest pain or significant T inversion. It is therefore important to different these patients from patients with acute coronary syndrome.

Transanal endorectal pull-through procedure versus transabdominal surgery for Hirschsprung disease: A systematic review and meta-analysis.

OBJECTIVE: To analyze the clinical results of transanal endorectal pull-through (TERPT) and transabdominal approach (TAB) in the treatment of Hirschsprung disease. METHODS: We searched all publications in the PubMed, MEDLINE, EMBASE, and Cochrane library databases between January 2003 and November 2018. The study included randomized controlled trials (RCTs) and observational clinical studies (OCSs), to compare the surgery duration, length of postoperative hospital stay, incidence of postoperative incontinence/soiling, constipation, and enterocolitis between the TERPT and TAB groups. Mantel-Haenszel method was used for continuous variables, the combined odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous variables were used. RESULTS: In the 87 studies, we include 1 case of RCTs and 9 cases of OCSs. Including 392 cases of TERPT and 332 cases of TAB groups. TERPT has a short postoperative hospitalization [mean difference (MD) = -6.74 day; 95% CIs; -13.26 to -0.23; P = .04], and a low incidence of postoperative incontinence (ORs = 0.54; 95% CIs, 0.35-0.83; P = .006) and constipation (ORs = 0.50; 95% CIs, 0.28-0.90; P = .02). There was no difference in duration of surgery (MD = -30.59 min; 95% CIs, -98.01-36.83; P = .37) and incidence of postoperative enterocolitis (ORs = 0.78; 95% CIs, 0.53-1.17; P = .23). CONCLUSION: TERPT is superior to TAB in terms of hospitalization time, postoperative incontinence, and constipation. However, there are still a large number of RCTs to verify, and more trials are expected to be testified in the future.

[Anemia as an independent predictor of poor long-term outcomes after percutaneous coronary intervention].

OBJECTIVE: To assess whether anemia is an independent predictor of poor long-term outcome after percutaneous coronary intervention (PCI). METHODS: The second drug-eluting stent impact on revascularization registry (DESIRE-2) is a single-center registry of 6005 patients undergoing coronary revascularization from July 2003 to September 2005. We examined the clinical data and outcome of 3809 PCI patients based on hemoglobin (Hb) value before the interventional procedure. Patients were classified as anemia using the World Health Organization definition (< 120 g/L in women and < 130 g/L in men). 744 of the 3809 patients were anemic. We compared the clinical features and prognosis of the patients with or without anemia. RESULTS: Anemic patients were older and had a higher percentage of comorbidities as compared with the nonanemic ones. When compared with nonanemic patients, anemic patients had higher mortality (4.7% vs 1.5%, P < 0.001) and higher major adverse event end points, including nonfatal myocardial infarction, stroke and revascularization (14.0% vs 10.8%, P = 0.014). After adjustment for comorbidities, anemia was associated with a higher risk of mortality after percutaneous coronary intervention (RR 2.216, 95% CI 1.019-4.428; P = 0.024). CONCLUSIONS: Anemia is an independent predictor of mortality after PCI. Since PCI is a common procedure and anemia is a frequent condition in the general population, strategies for the management of anemic PCI patients should be developed.

[The incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy].

OBJECTIVE: To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy (HCM). METHODS: 612 HCM patients were analyzed prospectively from July 1990 to November 2007. The age, sex, height, weight, medical history, main symptoms and incidence of atrial fibrillation were recorded. RESULTS: The patients' mean age was (47.8 +/- 14.9). 414 patients (67.6%) were male. 377 patients (61.6%) had left ventricular outflow truct obstruction. 94 patients (15.4%) and atrial fibrillation. 43 patients (6.0%) had sustained and 51 patients (9.4%) had paroxysmal. The patients with atrial fibrillation were older in age and were predominantly female. Their medical history were longer, left atrial diameter (LAD) longer and plasma B-type natriuretic peptide (BNP) higher. logistic regression analysis indicated that the medical history (P = 0.012), LAD (P = 0.0001) and BNP (P = 0.017) were the independent predictors of atrial fibrillation in HCM. Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke. CONCLUSIONS: The incidence of atrial fibrillation in HCM was high. The medical history, LAD and BNP were the independent predictors of its occurrence.

[Impact of admission heart rate on in-hospital mortality in patients with acute myocardial infarction].

OBJECTIVE: To evaluate the impact of admission heart rate (HR) on in-hospital mortality in patients with acute myocardial infarction. METHOD: The data of 904 in-hospital patients with ST-elevation myocardial infarction were collected from database of Beijing Anzhen Hospital during 2003--2004. The patients were divided into three groups according to the admission HR: < 80 beats/min, 80 - 90 beats/min and > 90 beats/min. Left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD) and the cases of in-hospital death were analyzed. RESULT: (1) Age, gender, smoking, hypertension, diabetes, the number of diseased vessel detected by coronary angiography were similar among three groups. LVEDD in group > 90 beats/min [(51.9 +/- 7.5) mm] and group 80 - 90 beats/min [(51.6 +/- 5.8) mm] were significantly larger compared with group < 80 beats/min [(50.3 +/- 5.3) mm, all P < 0.05]; LVESD in group > 90 beats/min [(39.5 +/- 8.7) mm] were also significantly increased compared with group 80 - 90 beats/min [(37.1 +/- 7.1) mm] and group < 80 beats/min [(34.8 +/- 6.2) mm, all P < 0.05]; LVEF was significantly lower in group > 90 beats/min (46.0% +/- 10.6%) compared with group 80 - 90 beats/min (49.5% +/- 11.3%) and group < 80 beats/min (54.6% +/- 10.8%, all P < 0.05). In-hospital mortality was significantly higher in group > 90 beats/min (18.2%) than those in group 80 - 90 beats/min and in group < 80 beats/min (8.5%, 3.9%, all P < 0.05). (2) Multivariate analysis showed that admission HR was an independent risk factor for in-hospital mortality (OR = 1.025, 95% CI 1.008 - 1.043, P = 0.005). CONCLUSION: The high level of admission HR was a powerful predictor of in-hospital mortality and ventricular remodeling in patients with acute myocardial infarction.

[Impact of drug-eluting stents on transferring treatment with coronary surgical revascularization among patients initially admitted to department of internal medicine].

OBJECTIVE: To evaluate the impact of drug-eluting stent (DES) on transferring treatment with coronary surgical revascularization among the patients initially admitted to department of internal medicine. METHODS: 2598 patients initially admitted in department of internal medicine underwent revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) before the introduction of DES from 1 July 2001 to 30 June 2002 [bare metal stent (BMS) era group, n = 923) or after the introduction of DES from 1 July 2003 to 30 June 2004 (DES era group). The clinical manifestations and coronary angiography characteristics were analyzed retrospectively. RESULTS: In the DES era group 1333 patients (80.1%) were revascularized with PCI, and 331 patients (19.9%) were transferred to treatment with CABG; and in the BMS era group, 721 patients (77.2%) underwent PCI, and 213 patients (22.8%) were transferred to treatment with CABG. The rate of transference to CABG of the DES era group was lower by 12.7% compared with the BMS era group. The rates of left main coronary disease, proximal left anterior descending coronary stenosis and diffuse long lesions among the patients revascularized with PCI in the DES era group were 3.2%, 44.2%, and 19.7% respectively, all significantly higher than those in the BMS era group (1.4%, 39.8%, and 11.2%, P = 0.025, P = 0.047, and = 0.021 respectively). But no matter if DES was implanted or not, left main coronary disease, proximal left anterior descending coronary stenosis, diffuse long lesions and ostial lesions were the most common coronary lesions in the patients revascularized with CABG. Logistic regression showed that number of diseased vessels, left main coronary disease, chronic total occlusion lesions, and proximal left anterior descending coronary stenosis were independent predictor for transferring treatment with CABG (all P < 0.0001). CONCLUSION: DES has a certain impact on the coronary revascularization strategies, because the rate of in-stent restenosis and repeat revascularization are lower significantly after implantation of DES than after implantation of BMS. Many coronary lesions that should undergo CABG in non-DES era may be revascularized with PCI and implantation of DES.

[Prevalence of unrecognized diabetes and risk factor control among patients with coronary heart disease and prognosis thereof].

OBJECTIVE: To evaluate the prevalence of unrecognized diabetes in patients with coronary heart disease, the control of the risk factors of CHD, and the long-term prognosis of these patients. METHODS: The clinical data of CHD patients with complete data, including clinical characters, target organ damage, percentage of controlled risk factors, and clinical results during follow up in the DESIRE (Drug-Eluting Stent Impact on REvascularization) database were analyzed. RESULTS: 3763 patients after revascularization for coronary heart disease were registered in the DESIRE database, 3683 of which had complete data recorded. 721 of the 3683 patients (19.8%) had established diabetes at admission, 303 (10.2%) without history of diabetes had fast glucose higher than the diagnostic criteria of diabetes. Another 722 patients had impaired fast glucose (IFG). 47.4% of the 3683 CHD patients had impaired glucose metabolism. The prevalence rates of systolic blood pressure>or=140 mm Hg, low density lipoprotein cholesterol>or=2.6 mmol/L, and current smoker at admission were 46.2%, 59.4%, and 48.8% respectively, all significantly higher than those of the established diabetes patients and those without (P=0.05, 0.0001, and 0.0001 respectively). The prevalence of three vessel disease was 41.6%, similar to that of the established diabetic patients (45.7%), and significantly higher than that of those without diabetic (P=0.0001). The percentage of creatinine>132 mmo/L signifying impaired renal function was 8.7% in the patients with unrecognized diabetes, significantly higher than those of the other 3 groups (all P=0.0001). 80.6% patients were followed up for a mean time of 30.0+/-12.1 months. The mortality rate of the patients with unrecognized diabetes was 5.7%, significantly higher than those of the patients with established diabetes (4.3%), those with IFG (3.6%), and those without diabetes (2.3%, all P=0.01). The rate of major adverse cardiac and cerebral events of the patients with unrecognized diabetes was 13.9%, similar to that of patients with established diabetes (14.3%), and significantly higher than that of the patients without diabetes (10.0%, P=0.01). CONCLUSION: The prevalence rate of diabetes is high in the CHD patients, the diagnosis of one third of which is missed. The target organ damages are more common and the risk factors control is poor among these patients. The prognosis of unrecognized patients after revascularization is poor in comparison with other groups.

[Prognosis of metabolic syndrome in coronary artery disease patients of different genders].

OBJECTIVE: To analyze the prevalence and characteristics of metabolic syndrome (MS) in the patients with coronary artery disease (CAD) of different genders who underwent revascularization. METHODS: The clinical data of 2596 patients in the DESIRE (Drug-eluting Stent Impact on Revascularization) study who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were analyzed and the patients were followed up till death. MS was diagnosed based on the Chinese standard (modified ATP III). RESULTS: The mean follow-up time was 828.8 +/- 373.2 days. 1139 of the 2596 patients were diagnosed as with MS. The prevalence of MS in the female patients was 50.9%, significantly higher than that in the male patients (41.8%, P < 0.0001). Complication of MS was the only predictive factor of poor prognosis in female CAD patients (OR = 2.019, 95% CI = 1.751 - 2.506, P = 0.023). Fasting blood glucose >or= 110 mg/dl was responsible for most of the increased risk associated with MS (adjusted OR 2.511, 95% CI 1.396 approximately 4.511, P = 0.002). CONCLUSION: In comparison with the male patients the female patients undergoing revascularization have a higher he prevalence of MS and worse prognosis. In the 4 elements of MS hyperglycemia is directly associated with prognosis.

[Impact of chronic anemia on in-hospital clinical outcome of revascularization in patients with coronary artery disease].

OBJECTIVE: To evaluate the in-hospital clinical outcome of revascularization in patients with coronary artery disease with chronic anemia. METHODS: Between July 2002 and June 2004, 3 679 patients in Anzhen Hospital Affiliated to Capital University of Medical Sciences were subjected to revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)] during hospitalization. These patients were divided into anemia group and non-anemia group according to blood hemoglobin (Hb) level [World Health Organization (WHO) standard (male<120 g/L, female<110 g/L) as anemia]. Rates of in-hospital main adverse cardiac and cerebral events (MACCE), including all-cause death, new attack of myocardial infarction, stroke and repeated revascularization were compared between two groups. RESULTS: There were 426 anemia patients (11.6%) and 3 253 non-anemia patients (88.4%). In-hospital death in the anemia group was higher than that of the non-anemia group [10 cases (2.4%) vs. 64 cases (1.9%), P<0.05]. Rates of MACCE of the anemia group was higher than that of the non-anemia group (4.2% vs. 3.2%, P<0.05). There was no significant difference in rates of new attack of myocardial infarction (0.7% vs. 0.6%), stroke (1.2% vs. 0.4%) and repeated revascularization (0 vs. 0.2%) between two groups (all P>0.05). CONCLUSION: Compared with non-anemia patients, anemia patients with coronary artery disease has higher in-hospital MACCE rate and all-cause mortality.

[Safety and efficacy comparison of myocardial contrast enhancement-guided and angio-pressure-guided transcoronary ablation of septal hypertrophy for patients with hypertrophic obstructive cardiomyopathy].

OBJECTIVE: To compare the safety and efficacy of myocardial contrast enhancement (MCE)-guided and angio-pressure (AP)-guided transcoronary ablation of septal hypertrophy (TASH) for patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: TASH was performed under MCE-guide (n = 47, group I) or AP-guide (n = 25, group II) for drug-refractory patients with HOCM. Myocardial perfusion imaging (MPI) data as well as other clinical data were compared. RESULTS: TASH both under MCE-guide or AP-guide resulted in similar and significant reduction of left ventricular outflow tract gradient (PG) and associated with significant symptom improvement (all P < 0.001). Dosage of ethanol use, peak-level of CK-MB and ablated myocardial area and incidence of arrhythmia were also similar between the two groups.Similar left ventricular/atrial dimension changes post TASH were observed in the 2 groups during follow-up. However, the first selected septal vessels were changed under MCE in 6 patients. CONCLUSIONS: Our data demonstrated that the MCE-guided TASH was not superior to AP-guided TASH in safety and efficacy. However, MCE-guided TASH can avoid the misplace of ethanol to avoid innocent myocardial ablation.

[The primary observation on the effect of pravastatin to non-ischemic heart failure].

OBJECTIVE: To investigate the efficacy and safety of adding pravastatin (Pra) on top of standard therapy in non-ischemic heart failure patients. METHODS: A total of 61 patients hospitalized in our hospital from Jan 2005 to Jul 2006 were randomly divided into pravastatin group (Pra 20 mg/d on top of standard therapy, n = 30) and control group (standard therapy, n = 31) and followed 6 months. The changes on cardiac function, flow-mediated vasodilatation (FMD) of brachial artery, plasma TNF-alpha level, liver and kidney function were observed. RESULTS: In Pra treated patients, FMD of brachial artery significantly increased after 3 months treatments and NYHA stage significantly improved, plasma BNP, TNF-alpha levels and left ventricular end-diastolic dimension significantly decreased, LVEF significantly increased significantly 6 months post therapy compared to baseline (all P < 0.01). In control group, the patients' NYHA stage also significantly improved (P < 0.05) and LVEF tended to be higher (P = 0.052) while FMD, plasma BNP and TNF-alpha levels remained unchanged at 6 months post therapy compared to baseline. In Pra group, the level of TC (P < 0.05) and LDL-C (P = 0.051) also significantly decreased while HDL-C remained unchanged 6 months post therapy. One patient in Pra group discontinued the study drug because of anaphylaxis. No event on liver and kidney dysfunction was noticed. CONCLUSION: Pravastatin was effective and safe in treating non-ischemic heart failure patients and can significantly improve left ventricular remodeling, endothelial and cardiac functions as well as reduce the levels of inflammatory factors.

Effect of metabolic syndrome on prognosis and clinical characteristics of revascularization in patients with coronary artery disease.

BACKGROUND: People with metabolic syndrome are at higher risk for developing coronary artery disease (CAD). The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease. METHODS: The DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829 +/- 373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome, using body mass index (BMI) instead of waist circumference. RESULTS: Of 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P < 0.0001), with higher creatinine [(10.5 +/- 4.3) mg/L vs (9.9 +/- 2.9) mg/L, P < 0.0001] and the number of white blood cells [(7.49 +/- 2.86) x 10(9)/L vs (7.19 +/- 2.62) x 10(9)/L, P = 0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or > or = 2-vessel) (73.6% vs 69.6%, P = 0.031). There were no significant differences of major adverse cardiac and cerebral events (MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P = 0.044). Fasting blood glucose (> or = 1000 mg/L) and triglyceride (TG, > or = 1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037 - 1.874, P = 0.032; OR 1.378, 95% CI 1.014 - 1.768, P = 0.044). CONCLUSIONS: The prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.