Impact of high-power short-duration atrial fibrillation ablation technique on the incidence of silent cerebral embolism: a prospective randomized controlled study.

BACKGROUND: High-power short-duration (HPSD) ablation strategy has emerged as a popular approach for treating atrial fibrillation (AF), with shorter ablation time. The utilized Smart Touch Surround Flow (STSF) catheter, with 56 holes around the electrode, lowers electrode-tissue temperature and thrombus risk. Thus, we conducted this prospective, randomized study to investigate if the HPSD strategy with STSF catheter in AF ablation procedures reduces the silent cerebral embolism (SCE) risk compared to the conventional approach with the Smart Touch (ST) catheter. METHODS: From June 2020 to September 2021, 100 AF patients were randomized 1:1 to the HPSD group using the STSF catheter (power set at 50 W) or the conventional group using the ST catheter (power set at 30 to 35 W). Pulmonary vein isolation was performed in all patients, with additional lesions at operator's discretion. High-resolution cerebral diffusion-weighted magnetic resonance imaging (hDWI) with slice thickness of 1 mm was performed before and 24-72 h after ablation. The incidence of new periprocedural SCE was defined as the primary outcome. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test. RESULTS: All enrolled AF patients (median age 63, 60% male, 59% paroxysmal AF) underwent successful ablation. Post-procedural hDWI identified 106 lesions in 42 enrolled patients (42%), with 55 lesions in 22 patients (44%) in the HPSD group and 51 lesions in 20 patients (40%) in the conventional group (p = 0.685). No significant differences were observed between two groups regarding the average number of lesions (p = 0.751), maximum lesion diameter (p = 0.405), and total lesion volume per patient (p = 0.669). Persistent AF and CHA2DS2-VASc score were identified as SCE determinants during AF ablation procedure by multivariable regression analysis. No significant differences in MoCA scores were observed between patients with SCE and those without, both immediately post-procedure (p = 0.572) and at the 3-month follow-up (p = 0.743). CONCLUSIONS: Involving a small sample size of 100 AF patients, this study reveals a similar incidence of SCE in AF ablation procedures, comparing the HPSD strategy using the STSF catheter to the conventional approach with the ST catheter. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04408716. AF = Atrial fibrillation, DWI = Diffusion-weighted magnetic resonance imaging, HPSD = High-power short-duration, ST = Smart Touch, STSF = Smart Touch Surround Flow.

Selective vs. Global Renal Denervation: a Case for Less Is More.

PURPOSE OF REVIEW: Review the renal nerve anatomy and physiology basics and explore the concept of global vs. selective renal denervation (RDN) to uncover some of the fundamental limitations of non-targeted renal nerve ablation and the potential superiority of selective RDN. RECENT FINDINGS: Recent trials testing the efficacy of RDN showed mixed results. Initial investigations targeted global RDN as a therapeutic goal. The repeat observation of heterogeneous response to RDN including non-responders with lack of a BP reduction, or even more unsettling, BP elevations after RDN has raised concern for the detrimental effects of unselective global RDN. Subsequent studies have suggested the presence of a heterogeneous fiber population and the potential utility of renal nerve stimulation to identify sympatho-stimulatory fibers or "hot spots." The recognition that RDN can produce heterogeneous afferent sympathetic effects both change therapeutic goals and revitalize the potential of therapeutic RDN to provide significant clinical benefits. Renal nerve stimulation has emerged as potential tool to identify sympatho-stimulatory fibers, avoid sympatho-inhibitory fibers, and thus guide selective RDN.

Diagnosis and prognosis of neutrophil gelatinase-associated lipocalin for acute kidney injury with sepsis: a systematic review and meta-analysis.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as an early biomarker for prediction of acute kidney injury (AKI). However, the utility of NGAL to predict the occurrence of AKI in septic patients remains controversial. We performed a systematic review and meta-analysis to evaluate the evidence on diagnosis of sepsis AKI and the prediction of other clinical outcomes. METHOD: The MEDLINE, EMBASE, Cochrane Library, Wanfang, and CNKI databases were systematically searched up to August 19, 2015. Quality assessment was applied by using the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tool. The diagnostic performance of NGAL for the prediction of AKI in sepsis was evaluated using pooled estimates of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio (DOR), as well as summary receiver operating characteristic curves (SROC). RESULTS: Fifteen studies with a total of 1,478 patients were included in the meta-analysis. For plasma NGAL, the pooled sensitivity and specificity with corresponding 95% confidence intervals (CI) were 0.83 (95% CI: 0.77 - 0.88) and 0.57 (95% CI: 0.54 - 0.61), respectively. The pooled positive likelihood ratio (PLR) was 3.10 (95% CI: 1.57 - 6.11) and the pooled negative likelihood ratio (NLR) was 0.24 (95% CI: 0.13 - 0.43). The pooled DOR was 14.72 (95% CI: 6.55 - 33.10) using a random effects model. The area under the curve (AUC) for SROC to summarize diagnostic accuracy was 0.86. For urine NGAL, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC values were 0.80 (95% CI: 0.77 - 0.83), 0.80 (95% CI: 0.77 - 0.83), 4.42 (95% CI: 2.84 - 6.89), 0.21 (95% CI: 0.13 - 0.35), 24.20 (95% CI: 9.92 - 59.05) and 0.90, respectively. Significant heterogeneity was explored as a potential source. There was no notable publication bias observed across the eligible studies. NGAL for prediction of renal replacement therapy (RRT) and mortality associated with AKI in septic patients were also evaluated. CONCLUSION: To a certain extent, NGAL is not only an effective predictive factor for AKI in the process of sepsis, but also shows potential predictive value for RRT and mortality. However, future trials are needed to clarify this controversial issue.

Efficacy and safety of phosphodiesterase type-5 inhibitors for pulmonary arterial hypertension: A meta-analysis focusing on 6MWD.

BACKGROUND AND OBJECTIVE: Phosphodiesterase type-5 inhibitors (PDE-5 inhibitors) have been suggested as a first-line drug for treating pulmonary arterial hypertension (PAH). The aim of present meta-analysis was to fully evaluate the efficacy and safety of treating PAH with PDE-5 inhibitors, focusing on the improvement of 6-min walk distance (6MWD). METHODS: Studies were identified from The Cochrane Library, EMBASE, and PUBMED databases. We calculated odds ratios (OR) for dichotomous data and weighted mean differences with 95% confidence intervals (CI) for continuous data. RESULTS: Six studies with a total of 1056 patients (729 patients in PDE-5 inhibitors treatment group and 327 patients in placebo group) were included. All-cause mortality rate in the control group and PDE-5 inhibitors group was 2.6% and 0.7%, respectively. In an average of 12.3-week follow-up, PDE-5 inhibitors treatment was associated with a 71% reduction in mortality (OR 0.29; 95 %CI 0.07-1.15; P = 0.08), and increased 6MWD by 40.17 m, improved NYHA functional class and hemodynamic parameters. As for monotherapy and combination therapy patients, 6MWD has improved by 48.94 m and 21.75 m, respectively. CONCLUSIONS: The results of present meta-analysis suggest that treatment with PDE-5 inhibitors improves the 6MWD, clinical symptoms, hemodynamic parameters, and a tendency of survival benefits. In patients treated with PDE-5 inhibitor monotherapy, the 6MWD significantly increased when compared to combination therapies.

[Prevalence and risk factors of atrial fibrillation in hospitalized patients with chronic kidney disease].

OBJECTIVE: Atrial fibrillation (AF) is the most common sustained tachyarrhythmia in the general population. AF and Chronic Kidney Disease (CKD) share several common risk factors. We investigated the association between chronic kidney disease and risk of atrial fibrillation in hospitalized patients with CKD. METHODS: One thousand one hundred and sixty-eight patients [(63.3 ± 14.2) years, 54.5% males] hospitalized CKD patients were included. AF was determined by electrocardiogram or medical history. The prevalence of atrial fibrillation was compared in CKD patients with various age, sex and glomerular filtration rate (eGFR). Binary logistic regression analysis was used to determine the risk factors of AF. RESULT: The mean eGFR was (22.2 ± 19.7) ml · min(-1) · 1.73 m(-2); eGFR was ≤ 45 ml · min(-1) · 1.73 m(-2) in 84.2% patients and 38.5% patients received hemodialysis. AF was present in 14.2% of the study population and 17.2% in patients ≥ 60 years old. Prevalence of AF was significantly higher in patients with eGFR ≤ 45 ml · min(-1) · 1.73 m(-2) compared patients with eGFR > 45 ml · min(-1) · 1.73 m(-2) (15.8% vs. 5.4%, P < 0.001). Binary logistic regression analysis showed that age, body mass index (BMI), heart failure (HF), left atrial diameter (LAD), eGFR and dialysis were independent risk factors for AF. CONCLUSIONS: AF is much more frequent in CKD patients than in the general population. Age, BMI, HF, LAD, eGFR and dialysis are risk factors for AF in hospitalized patients with CKD.

One-year clinical outcome of a randomized trial of polymer-free paclitaxel-eluting stents versus biodegradable polymer-based rapamycin-eluting stents in patients with coronary heart disease.

BACKGROUND: More widespread use of drug-eluting stents (DES) to treat coronary heart disease (CHD) has recently generated more attention to thrombosis, which was relative to the polymer. Polymer-free and biodegradable polymer-based stents are more frequently studied, but their efficacy on preventing detrimental clinical events is unclear. METHODS AND RESULTS: To assess whether polymer-free paclitaxel-eluting stent (YINYI stent) was noninferior or equivalent to biodegradable polymer-based rapamycin-eluting stents (EXCEL stent) in preventing detrimental clinical cardiovascular events, a total of 167 consecutive CHD patients requiring DES implantation were randomly divided into the YINYI group (n = 82) and the EXCEL group (n = 85). The primary end-point was major adverse cardiac events (MACE). The secondary end-points included stent thrombosis events, all-cause mortality, and rehospitalization. The study was designed to test the noninferiority or equivalence of the YINYI stent compared with the EXCEL stent with respect to one-year MACE according to a noninferiority or equivalence margin of 0.1. One-year MACE was 6.10% in the YINYI group versus 5.88% in the EXCEL group. The lower limit of the one-sided 95% confidence interval was -0.0582 (P = 0.002 from the test for noninferiority). The 95% confidence interval for the equivalence test was [-0.0698, 0.0742] (P1 =0.004 and P2 =0.007 from 2 times the 1-sided test for equivalence). There was no statistically significant difference in thrombosis events, all-cause death, and rehospitalization (all P > 0.05). CONCLUSIONS: In this small randomized trial, polymer-free paclitaxel-eluting stents appear to be noninferior or equivalent to biodegradable polymer-based rapamycin-eluting stents.

[Efficacy of rate and rhythm control strategy in patients with atrial fibrillation: meta-analysis].

OBJECTIVE: The efficacy of rate and rhythm control strategies for treating atrial fibrillation (AF) patients was analyzed in this meta-analysis. METHODS: Eligible trials were searched in MEDLINE, the Cochrane Library, the Clinical Trials, the Chinese VIP database up to May 31, 2010. Ten prospective randomized control trials with 7876 patients (rate control n = 3932, rhythm control n = 3944) were included for final analysis. RESULTS: All cause mortality (5.3% vs. 5.0%; OR: 1.03; 95%CI: 0.84 - 1.26; I(2) < 25%) and incidence of worsening heart failure (3.81% vs. 3.61%; OR: 1.04; 95%CI: 0.80 - 1.36; I(2) < 50%) were similar between the two groups. Subgroup analysis showed that all cause mortality (3.6% vs.1.9%; OR: 1.89; 95%CI: 1.01 - 3.53; I(2) < 25%) and rate of worsening heart failure (2.3% vs. 0.3%; OR: 5.6; 95%CI: 1.44 - 21.69; I(2) < 25%) were significantly higher in rate control group than in rhythm control group in patients with age < 65 years. Thromboembolic events (1.49% vs. 1.46%; OR: 1.02, 95%CI: 0.71 - 1.48) and bleeding events (1.78% vs. 1.73%; OR: 1.02, 95%CI: 0.70 - 1.49) were similar between rhythm control and rate control groups while rehospitalization rate was significantly lower in rate control group than in rhythm control group (17.56% vs. 22.98%; OR: 0.37, 95%CI: 0.19 - 0.71). CONCLUSION: This meta-analysis shows that rhythm control strategy is superior to rate control strategy for AF patients with age < 65 years in terms of reducing all cause mortality and incidence of worsening heart failure.

Differential diagnosis of pulmonary nodular mucinous adenocarcinoma and tuberculoma with dynamic CT: a retrospective study.

Background: Pulmonary nodular mucinous adenocarcinoma (PNMA) tends to be easily misdiagnosed as tuberculoma in practice. In this study, we aimed to discriminate PNMA from tuberculoma with dynamic computed tomography (CT). Methods: In this study, 38 consecutive pathologically confirmed cases of PNMA and 23 cases of tuberculoma from January 2015 to December 2019 were retrospectively collected. The mean CT attenuations of each lesion were examined. The values on the plain scan, the venous scan, and the enhanced values (CT attenuation of lesion of venous scan minus that of the plain scan) were tested with an independent t-test pair-wisely. Receiver operating characteristic (ROC) curve analyses were performed to test the differential diagnosis values. The presence of satellite lesions was determined with the chi-square test. Results: The mean CT attenuation of tuberculoma shown on the plain scan was significantly higher than that of PNMA (35.15±16.00 vs. 24.00±12.67 HU; P<0.01). The enhanced value of tuberculoma on venous scan was significantly lower than that of PNMA (13.44±13.40 vs. 22.52±14.00 HU; P=0.02). The optimum CT attenuation of the plain scan and the enhanced value for differential diagnosis were 28.80 and 14.25 HU [area under the curve (AUC) =0.72, 95% confidence interval (CI): 0.58-0.86; and AUC =0.70, 95% CI: 0.59-0.84], with sensitivity (78.3% vs. 71.1%) and specificity (63.8% vs. 69.6%) respectively. The satellite lesions were more often observed in the tuberculoma group (P<0.01). Conclusions: The CT attenuation of the plain scan, the enhanced value after enhancement, and the presence of satellite lesions might be useful in differentiating PNMA from tuberculoma.

Application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis.

BACKGROUND: Central lung cancer with obstructive atelectasis is very common in clinical practice. Determination of the tumor borderline is important. Conventional computed tomography (CT) alone may not be sufficiently accurate to distinguish central lung cancer from obstructive atelectasis. Spectral CT can improve the soft-tissue resolution greatly. In this study, we evaluated the application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis. METHODS: A total of 51 patients (37 males) with pathologically confirmed central lung cancer accompanied by atelectasis were enrolled. The rates of differentiation between tumors and atelectasis were retrospectively analyzed using conventional CT and three types of spectral images (40 keV virtual monoenergetic imaging, iodine density map, and their fusion image) of unenhanced scans as well as arterial and venous phases. Cochran's Q test and Friedman test were used to compare the differentiation rates and the maximal diameters of the tumors in each image. RESULTS: Among the 51 cases, conventional CT, 40 keV monoenergetic, iodine density, and their fusion images of the venous phase were successful in differentiating tumors from atelectasis in 17 (33.33%), 35 (68.63%), 39 (76.47%), and 38 (74.51%) cases, respectively. The differentiation rates of the 40 keV monoenergetic, iodine density, and fusion images were significantly higher than those of conventional images (χ2=-0.35, -0.43, and -0.41, respectively, all P<0.001). There were no significant differences in the differentiation rates among the 40 keV monoenergetic, iodine density, and fusion images (χ2=-0.06, -0.08, 0.02, respectively, all P=1.00). The maximal tumor diameters in the four images did not significantly differ (χ2=3.61, P=0.31). Conventional and spectral images of unenhanced and arterial phases could not/barely identify the tumor borderlines. CONCLUSIONS: Venous-phase spectral images of double-layer spectral detector CT can differentiate most central lung cancers from atelectasis, and the maximal diameter measurement of the tumor is reliable. Double-layer spectral detector CT can accurately identify the borderlines of most central lung cancers through spectral images during routine CT examinations without requiring other imaging modalities. Therefore, this method has considerable clinical value for applications in tumor staging, efficacy evaluation, and radiotherapy.

Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial.

BACKGROUND: Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block. METHODS AND RESULTS: A total of 509 patients underwent slow pathway cryoablation (n=251) or RFCA (n=258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; P=0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; P=0.029). In the cryoablation group, procedure duration was longer (138±54 versus 123±48 minutes; P=0.0012) and more device problems occurred (13 versus 2 patients; P=0.033). Pain perception was lower in the cryoablation group (P<0.001). CONCLUSIONS: Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00196222.

Efficacy and Safety of Long-Term Oral Bosentan in Different Types of Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review and meta-analysis was conducted to identify if long-term bosentan is an effective and safe treatment for pulmonary arterial hypertension (PAH) regardless of type, including idiopathic PAH (IPAH), and PAH associated with congenital heart disease (APAH-CHD), connective tissue disease (APAH-CTD), and human immunodeficiency virus (APAH-HIV). METHODS: All relevant observations were systematically searched by two independent investigators and obtained from three databases, including PubMed, EMBASE and the Cochrane Library, from the inception of each database to February 2020. Currently, long-term administration was defined as no less than 12 months. A random-effects or fixed-effects model was selected according to outcomes of the heterogeneity test for meta-analysis, where standardized mean difference (SMD) with 95% confidence intervals (CIs) was used for continuous outcomes, in addition to the estimated effect (ES; 95% CI) for the synthesized survival rate. Furthermore, subgroup analysis was applied to analyze the differences of efficacy and survivals in each type of PAH cohort. RESULTS: Fifteen studies including a total of 659 subjects undergoing oral bosentan administration for at least 12 months were pooled in this quantitative review. Meta-analysis and subgroup analysis indicated that significant clinical benefits existed, including an improved 6-min walk distance (6MWD) and functional class (FC), in patients with APAH-CHD (6MWD: SMD 0.72, 95% CI 0.52-0.93, p < 0.0001; functional benefits: 50.4%, 95% CI 43.7-57.1%), APAH-HIV (6MWD: SMD 0.83, 95% CI 0.36-1.30, p = 0.001; functional benefits: 80.4%), and IPAH (SMD 0.54, 95% CI 0.28-0.80, p < 0.0001; functional benefits: 61.4%, 95% CI 54.2-68.5%), but a non-significant change in APAH-CTD (6MWD: SMD 0.18, 95% CI - 0.60 to 0.95, p = 0.656; functional benefits: 27.5%). Furthermore, among the hemodynamic parameters, long-term bosentan led to a significant decrease in mean pulmonary artery pressure (SMD - 0.86, p < 0.0001) in APAH-CTD, and a decrease in pulmonary vascular resistance (SMD - 0.65, p < 0.0001) and elevated oxygen saturation (SMD 0.30, p = 0.006) in APAH-CHD. Importantly, in all pooled studies, the overall survival indicated 1-, 2-, and 3-year survival rates of 94.3%, 88.8%, and 81.7%, respectively, in all-cause PAH, and subgroup analysis demonstrated a relative decreasing trend in patients with HIV, from a 2-year survival of 89.8% to a 3-year survival of 66.1%. Adverse drug reactions were relatively mild. CONCLUSION: In this systematic review and meta-analysis, long-term administration of oral bosentan has been identified as a well-tolerated and effective agent in different types of PAH. In addition, we conclude that long-term oral bosentan should be considered for patients with CTD to achieve a satisfactory exercise capacity, and for those with APAH-HIV to improve survivals, where more attention on adverse events is required.

Better CRT Response in Patients Who Underwent Atrioventricular Node Ablation or Upgrade From Pacemaker: A Nomogram to Predict CRT Response.

Background: Response rates for cardiac resynchronization therapy (CRT) in patients without intrinsic left bundle-branch block (LBBB) morphology are poor. Objective: We sought to develop a nomogram model to predict response to CRT in patients without intrinsic LBBB. Methods: We searched electronic health records for patients without intrinsic LBBB who underwent CRT at Mayo Clinic. Logistic regression and Cox proportional hazards regression analysis were performed for the odds of response to CRT and risk of death, respectively. Results were used to develop the nomogram model. Results: 761 patients without intrinsic LBBB were identified. Six months after CRT, 47.8% of patients demonstrated improvement of left ventricular ejection fraction by more than 5%. The 1-, 3-, and 5-year survival rates were 95.9, 82.4, and 66.70%, respectively. Patients with CRT upgrade from pacemaker [odds ratio (OR), 1.67 (95% CI, 1.05-2.66)] or atrioventricular node (AVN) ablation [OR, 1.69 (95% CI, 1.09-2.64)] had a greater odds of CRT response than those patients who had new implant, or who did not undergo AVN ablation. Patients with right bundle-branch block had a low response rate (39.2%). Patients undergoing AVN ablation had a lower mortality rate than those without ablation [hazard ratio, 0.65 (95% CI, 0.46-0.91)]. Eight clinical variables were automatically selected to build a nomogram model and predict CRT response. The model had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.63-0.78). Conclusions: Among patients without intrinsic LBBB undergoing CRT, upgrade from pacemaker and AVN ablation were favorable factors in achieving CRT response and better long-term outcomes.

Coronary score adds prognostic information for patients with acute coronary syndrome.

BACKGROUND: The aim of the present study was to explore the association of 3 coronary scores with major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). METHODS AND RESULTS: The 958 consecutive patients with ACS were followed up until either MACE or 31(st) December 2008 occurred; 257 patients reached clinical endpoints. Cox regression analysis demonstrated that the Gensini score was associated with 90-day MACE (relative risk (RR) 1.021, P=0.004), 6-month MACE (RR 1.021, P<0.001), 1-year MACE (RR 1.017, P=0.002), and MACE during follow-up (RR 1.010, P=0.040). Leaman score was associated with 90-day MACE (RR 1.094, P=0.014), 6-month MACE (RR 1.098, P=0.002), and 1-year MACE (RR 1.074, P=0.009). The logistic regression analysis demonstrated that the Gensini score (odds ratio (OR) 1.037, P=0.001), Leaman score (OR 1.165, P=0.007) and American College of Cardiology/American Heart Association (ACC/AHA) score (OR 1.235, P=0.025) were all associated with cardiogenic death. CONCLUSIONS: The Gensini score provides more valuable prognostic information on cardiovascular risk than either the Leaman or ACC/AHA score in patients with ACS.

Cardiac resynchronization therapy modulates peripheral sympathetic activity.

BACKGROUND: Heightened sympathetic nerve activity has been associated with poorer prognosis in patients with reduced left ventricular systolic function (ie, heart failure with reduced ejection fraction [HFrEF]). OBJECTIVE: The purpose of this study was to investigate the effects of cardiac resynchronization therapy (CRT) on sympathetic nerve activity, measured by average skin sympathetic nerve activity (aSKNA). METHODS: This prospective study enrolled 36 patients with HFrEF who received CRT. Ten patients who received an implantable cardioverter-defibrillator for primary prevention served as controls. Patient clinical data, echocardiographic variables, and aSKNA at baseline and 3-month follow-up were collected. RESULTS: CRT patients who exhibited wider QRS duration had higher aSKNA (1.52 ± 0.65 µV vs 0.97 ± 0.49 µV; P = .027) compared to the control group at baseline. In the CRT group, patients with QRS duration ≥150 ms had higher aSKNA than those with QRS duration <150 ms (1.67 ± 0.63 µV vs 1.19 ± 0.51 µV; P =.039). After CRT, left ventricular ejection fraction (LVEF) improved from 29.6% to 35.4% (P = .001). aSKNA decreased significantly (1.52 ± 0.65 µV vs 1.31 ± 0.63 µV; P = .018). Seventeen of the 36 CRT patients were CRT responders, with LVEF improvement ≥5% at 3-month follow-up. aSKNA significantly decreased from 1.47 to 1.15 µV (P = .003) in CRT responders but was unchanged in nonresponders (1.44 ± 0.69 to 1.37 ± 0.70; P = .61). After CRT, a significant reduction in aSKNA was associated with improvement in LVEF (r = 0.638; P = .001). CONCLUSION: CRT reduces elevated sympathetic activity in HFrEF patients, accompanied by improvement in systolic function at short-term follow-up. The reduction of sympathetic activity is mainly seen in CRT responders.

The Impact of Renal Denervation on the Progression of Heart Failure in a Canine Model Induced by Right Ventricular Rapid Pacing.

Heart failure (HF) has been proposed as a potential indication of renal denervation (RDN). However, the mechanisms enabling RDN to attenuate HF are not well understood, especially the central effects of RDN. The aim of this study was to decipher the mode of operation of RDN in the treatment of HF using a canine model of right ventricular rapid pacing-induced HF. Accordingly, 24 Chinese Kunming dogs were randomly grouped to receive sham procedure (sham-operated group), bilateral RDN (RDN group), rapid pacing to induce HF (HF-control group), and bilateral RDN plus rapid pacing (RDN + HF group). Echocardiography, plasma brain natriuretic peptide (BNP), and norepinephrine (NE) concentrations of randomized dogs were measured at baseline and 4 weeks after interventions, followed by histological and molecular analyses. Twenty dogs completed the research successfully and were enrolled for data analyses. Results showed that the average optical density of renal efferent and afferent nerves were significantly lower in the RDN and RDN + HF groups than in the sham-operated group, with a significant reduction of renal NE concentration. Rapid pacing in the RDN + HF and HF-control groups, compared with the sham-operated group, induced a significant increase in left ventricular end-diastolic volume and decrease in left ventricular ejection fraction and correspondingly resulted in cardiac fibrosis and dysfunction. Cardiac fibrosis evaluated by Masson's trichrome staining and the expression of transforming growth factor-ß1 (TGF-ß1) were significantly higher in the HF-control group than in the sham-operated group, which were remarkably attenuated by the application of the RDN technique in the RDN + HF group. In terms of central renin-angiotensin system (RAS), the expression of angiotensin II (AngII)/angiotensin-converting enzyme (ACE)/AngII type 1 receptor (AT1R) in the hypothalamus of dogs in the HF-control group, compared with the sham-operated group, was upregulated and that of the angiotensin-(1-7) [Ang-(1-7)]/ACE2 was downregulated. Furthermore, both of them were significantly attenuated by the RDN therapy in the RDN + HF group. In conclusion, the RDN technique could damage renal nerves and suppress the cardiac remodeling procedure in canine with HF while concomitantly attenuating the overactivity of central RAS in the hypothalamus.

[Renin-angiotensin system blocking agents reverse the myocardial hypertrophy in experimental hyperthyroid cardiomyopathy via altering intracellular calcium handling].

OBJECTIVE: To explore the mechanisms of myocardial hypertrophy induced by Levothyroxine (L-Thy). METHODS: A rabbit model of hyperthyroidism was established by daily intraperitoneal injections of L-Thy (45 microg/kg per day) for 28 days. New Zealand rabbits were randomly divided into four groups (n = 10 each): control group, L-Thy group (L-Thy alone), imidapril group (L-Thy + 0.5 mg/kg imidapril), and valsartan group (L-Thy + 8 mg/kg valsartan). All rabbits were treated for 4 weeks. At the end of the treatments, all rabbits underwent echocardiography and IVS, LV and LVPW thickness were measured. Ventricular tissues were then collected.Cardiac hypertrophy index, cardiomyocyte diameter, structural and ultrastructural changes were obtained. Ventricular myocytes were isolated by enzymatic digestion method and intracellular Ca2+ concentration was determined with the fluorescent Ca2+ indicator Fluo3/AM and laser scanning confocal microscopy. Activity of Sarco/Endoplasmic reticulum Ca2+ ATPase (SERCA) was evaluated with P-NPP method.mRNA expression of L-type Ca2+ channel (LCC), ryanodine receptor (RyR), and SERCA was semi-quantified with RT-PCR. Protein of IP3R was localized by immunostaining and semi-quantified with pathological image analytic system. RESULTS: Compared with control group, rabbits treated with L-Thy displayed remarkable myocardial hypertrophy and morphological changes in both structure and ultrastructure levels. Increased intracellular Ca2+ concentration [(576.2 +/- 41.7) nmol/L vs. (314.6 +/- 35.6) nmol/L, P < 0.01] and decreased SERCA activity [(0.062 +/- 0.013) micromol x min(-1)xg(-1) vs. (0.133 +/- 0.022) micromol x min(-1)xg(-1), P < 0.01] were detected in L-Thy treated rabbits. RT-PCR analysis and (or) immunohistochemistry revealed decreased mRNA expression of LCC mRNA (0.48 +/- 0.11 vs. 0.75 +/- 0.16, P < 0.01) and increased RyR mRNA (1.19 +/- 0.21 vs. 0.73 +/- 0.15, P < 0.01), SERCA mRNA (1.01 +/- 0.08 vs. 0.76 +/- 0.09, P < 0.01) and IP3R protein (65.3 +/- 13.7 vs. 47.9 +/- 10.2, P < 0.01) expression in L-Thy treated rabbits. Both imidapril and valsartan could significantly attenuate cardiomyocyte hypertrophy and structural remodeling induced by L-Thy. Compared with L-Thy group, decreased intracellular Ca(2+) concentration [(376.4 +/- 32.5) nmol/L vs. (576.2 +/- 41.7) nmol/L, P < 0.01 and (392.6 +/- 41.2) nmol/L vs. (576.2 +/- 41.7) nmol/L, P < 0.01, respectively], and increased LCC mRNA (0.68 +/- 0.14 vs. 0.48 +/- 0.11, P < 0.01; 0.64 +/- 0.13 vs. 0.48 +/- 0.11, P < 0.01, respectively) and SERCA activity [(0.115 +/- 0.019) micromol x min(-1)xg(-1) vs. (0.062 +/- 0.013) micromol x min(-1)xg(-1), P < 0.01; (0.109 +/- 0.015) micromol x min(-1)xg(-1) vs. (0.062 +/- 0.013) micromol x min(-1)xg(-1), P < 0.01, respectively] were found in both imidapril and valsartan treated rabbits, but expression of RyR, SERCA and IP3R remained unchanged. CONCLUSION: Intracellular Ca(2+) overload may play important roles in myocardial hypertrophy induced by L-Thy. Imidapril and valsartan may exert beneficial effects on hyperthyroid myocardial hypertrophy via altering intracellular calcium handling.

[Predict value of clinical risk score, thrombolysis in myocardial infarction flow grade and combined clinical risk score plus TIMI flow on outcome evaluation of patients with acute coronary syndrome].

OBJECTIVE: To compare the prognostic value of clinical risk score and thrombolysis in myocardial infarction (TIMI) flow grade alone or combined on outcome of acute coronary syndrome (ACS). METHODS: A total of 206 eligible patients [135 males, mean age (67.57 +/- 9.88) years] were enrolled. The primary endpoints included cardiac death and non-cardiac death. The secondary endpoints included non-fatal stroke, reinfarction, heart failure and recurrent angina. Receiver operating characteristic curve (ROC) established by using different endpoints and clinical risk score, TIMI flow grade or combined risk scores. The prognostic value for different endpoint expressed as the area under the curve (AUC). RESULTS: Eleven patients lost during the (11.41 +/- 5.33) months follow up and data were available for 195 patients, 8 patients reached the primary endpoints, and 17 patients reached the secondary end-points at the end of follow up. The AUC was 0.67 (95% CI = 0.557 approximately 0.786), P = 0.006; 0.68 (95% CI = 0.557 approximately 0.786), P = 0.004 and 0.730 (95% CI = 0.691 approximately 0.815), P < 0.001, respectively for clinical risk score, TIMI flow grade and the combined risk score respectively. There were no significant differences among clinical risk score, TIMI flow grade and combined risk score (all P > 0.05) for AUC and for primary end point and the secondary end point. CONCLUSION: The result from this study suggests that the efficacy of predicting the total events based on clinical risk score, TIMI flow grade and combined risk score was similar.

[Expression of angiotensin converting enzyme and angiotensin II receptor in rabbits with hyperthyroid cardiomyopathy].

OBJECTIVE: To explore the pathogenesis of hyperthyroid cardiomyopathy. METHODS: A rabbit model of hyperthyroid cardiomyopathy was reproduced by daily intraperitoneal injection of L-thyroxine (L-Thy, 45 microg x kg(-1)xd(-1)) for 28 consecutive days. Forty New Zealand rabbits were randomly divided into four groups: control group, L-Thy group, imidapril group, and valsartan group. Ventricular tissues were harvested after 4 weeks. Cardiac hypertrophy index and cardiomyocyte diameter were assessed. Cardiac fibrosis was shown by Masson's stain and collagen volume fraction (CVF) was measured using pathological image analytic system. Plasma and cardiac angiotensin II (AngII) concentration were measured with radioimmunoassay (RIAs). mRNA expression of angiotensin converting enzyme(ACE), one tape angiotensin recipient-II(AT1R) and AT2R were semi-quantified with reverse transcription-polymerase chain reaction (RT-PCR). Expression of ACE, AT1R and AT2R protein were evaluated with Western blotting analysis. RESULTS: Compared with control group, rabbits treated with L-Thy only were found to have remarkable myocardial hypertrophy and extracellular matrix fibrosis. Increased plasma and tissue AngII were detected in L-Thy group. RT-PCR and Western blotting analysis revealed enhanced mRNA and protein expression of ACE, AT1R and AT2R. It was also demonstrated that both imidapril and valsartan alleviated cardiac hypertrophy and extracellular matrix fibrosis induced by L-Thy. Compared with L-Thy and valsartan group, imidapril group showed significantly lower plasma /tissue AngII concentration and more effective inhibition of extracellular matrix fibrosis. Imidapril did not alter the expression of ACE, AT1R or AT2R. Plasma concentration of AngII was markedly higher in valsartan group compared with L-Thy group, whereas tissue AngII concentration showed no significant difference between two groups. In valsartan group, AT1R and AT2R mRNA expressions were significantly upregulated, whereas valsartan did not change mRNA and protein expression of ACE. CONCLUSION: Renin-angiotensin system (RAS) may play an important role in hyperthyroid cardiomyopathy. Imidapril and valsartan may exert beneficial effects on hyperthyroid cardiomyopathy via retarding myocardial remodeling.

[Relationship between body mass index, waist circumference and blood pressure among 5246 residents in Chongqing area].

OBJECTIVE: To explore the relationship between body mass index, waist circumference and blood pressure among residents in Chongqing area. METHODS: A total of 5246 residents aged 15 and over in Chongqing area were enrolled in this study by use of stratified sampling and cluster sampling methods. Data on blood pressure (SBP, DBP), pulse, height, body weight, waist and hip circumferences as well as questionnaire survey were analyzed. RESULTS: The level of SBP and DBP and hypertension prevalence rate were significantly positively correlated with BMI (all P < 0.01). SBP, DBP levels and hypertension prevalence rate were significantly higher in people with abdomen obesity than people with normal waist circumference (all P < 0.01). BMI, waist circumference in hypertensive residents were significantly higher than non-hypertensive residents (all P < 0.01). CONCLUSION: Blood pressure level and hypertension prevalence rate were closely related with BMI and waist circumference among residents in Chongqing area.

[Chronic effects on the prevention of atrial fibrillation recurrence in patients with lone paroxysmal atrial fibrillation treated with amiodarone, segmental pulmonary vein ablation, or amiodarone plus losartan: a prospective cohort study].

OBJECTIVE: This study was designed to compare clinical efficacy of segmental pulmonary vein ablation (SPVI), amiodarone or amiodarone plus losartan on sinus rhythm maintenance in patients with lone paroxysmal atrial fibrillation (PAF). METHODS: Patients with lone PAF were treated with amiodarone alone (A, n = 52), segmental pulmonary vein isolation (SPVI, n = 51), or amiodarone plus losartan (AL, n = 51). The primary endpoint of this study was the incidence of symptomatic atrial tachyarrhythmia (> 30 s) documented by 12 lead ECG or Holter during 12 months follow-up period. RESULTS: During follow-up, AF was documented in 24 patients (46.2%) in A group, 11 patients (21.6%) in SPVI group and 12 (23.5%) in AL group (P < 0.05 vs. A group). The Kaplan-Meier survival analysis demonstrated a significant equally reduction in AF recurrence in SPVI and AL groups (P = 0.009, log-rank test and P = 0.018, log-rank test, respectively) compared with A group. The hazard ratio for AF recurrence in patients treated with SPVI and amiodarone plus losartan was 0.41 (95% CI 0.200 to 0.848, P = 0.016) and 0.46 (95% CI 0.225 to 0.953, P = 0.036), respectively. Incidences of major adverse cardiac events were similar among the groups (9.6% in A, 3.9% in SPVI and 7.8% in AL group, P > 0.05). CONCLUSION: The results of this study suggest that the segmental pulmonary vein isolation and amiodarone plus losartan are superior to amiodarone alone for preventing AF recurrence in patients with lone PAF.