The Simplified Thrombo-Inflammatory Score as a Novel Predictor of All-Cause Mortality in Patients with Heart Failure: A Retrospective Cohort Study.

Background: The simplified thrombo-inflammatory score (sTIPS) has recently emerged as a novel prognostic score. Hence, we investigated the prognostic value of sTIPS for predicting long-term mortality in patients with heart failure (HF). Methods: A total of 3741 patients were analyzed in this study. The sTIPS was calculated based on the white blood cell count (WBC) and the mean platelet volume to platelet count (MPV/PC) ratio at admission. The mean follow-up time was 22.75 months. Multivariable Cox regression analyses were used to investigate the associations between the sTIPS and all-cause mortality (ACM). Results: In the whole study population, multivariate Cox regression analysis showed that patients in both the sTIPS 2 and sTIPS 1 groups had significantly increased risk of ACM as compared with patients in the sTIPS 0 group (hazard ratio [HR]=1.706, 95% confidence interval [CI]: 1.405-2.072, P<0.001 and HR = 1.431, 95% CI 1.270-1.612, P<0.001). The same significant trend was observed in heart failure with preserved ejection fraction (HFpEF) patients (sTIPS1 vs sTIPS0: HR = 1.366, 95% CI 1.100-1.697, P = 0.005; sTIPS2 vs sTIPS0: HR = 1.995, 95% CI 1.460-2.725, P<0.001). However, only sTIPS 1 group had a significantly increased the risk of ACM compared to the sTIPS 0 group among patients with HFmrEF (sTIPS1 vs sTIPS0: HR = 1.648, 95% CI 1.238-2.194, P = 0.001) and HFrEF (sTIPS1 vs sTIPS0: HR = 1.322, 95% CI 1.021-1.712, P = 0.035). Conclusion: sTIPS is useful in predicting risk for long-term mortality in patients with HF.

Regulation of calcium pump through Notch/Jagged/Hes signaling pathway in canine model of chronic atrial fibrillation.

OBJECTIVE: Using a canine model of atrial fibrillation (AF) induced by chronic pacing of left atrial fibrillation, the present study aimed to investigate the protein expression and content change of Notch-1 and its downstream target genes including Hes1, Jagged1, and SERCA2a in the atrial myocardium of canines with chronic AF. Furthermore, the correlation between Notch-1/Hes1/Jagged1 and the SERCA2a calcium pump was also analyzed. METHODS: Ten healthy Beagle dogs including both males and females, aged 7-9 years were randomly divided into a sham group (n = 5) and AF group (n = 5). The AF group underwent minimally invasive surgery with implantation of a pacemaker into the left atrial appendage for induction of AF. After 8 weeks of pacemaker implantation, animals were euthanized and specimens from the right and left atrial free walls were excised for histologic and biochemical analyses. RESULTS: After 8 weeks' pacemaker implantation, immunohistochemical expression of Notch-1, Hes1, Jagget1 and SERCA2a in the sham group was positive. Compared with the sham operation group, the intensity of Notch-1, Hes1 and Jagget1 in AF group was stronger with a significant increasing trend in the intensity of the color, respectively. The expression of SERCA2a was weak; the intensity decreased significantly (P < 0.05). Pearson correlation analysis revealed that in the AF group, Notch-1 was negatively correlated with SERCA2a (r = -0.77, P = 0.028), and was positively correlated with Hes1 and Jagged1 (r = 0.92, P = 0.014; r = 0.73, P = 0.030) proteins, respectively. CONCLUSION: The activation of the Notch signaling pathway was associated with a decrease in SERCA2a protein expression and contributes to the development and maintenance of electrical remodeling in AF through modulation of calcium pump function and calcium homeostasis.

Changes in microRNAs expression are involved in age-related atrial structural remodeling and atrial fibrillation.

BACKGROUND: Small noncoding microRNAs regulate gene expression in cardiac development and disease and have been implicated in the aging process and in the regulation of extracellular matrix proteins. However, their role in age-related cardiac remodeling and atrial fibrillation (AF) was not well understood. The present study was designed to decipher molecular mechanisms underlying age-related atrial structural remodeling and AF. METHODS: Three groups of dogs were studied: adult and aged dogs in sinus rhythm and with persistent AF induced by rapid atrial pacing. The expressions of microRNAs were measured by quantitative real-time polymerase chain reaction. Pathohistological and ultrastructural changes were tested by light and electron microscopy. Apoptosis index of myocytes was detected by TUNEL. RESULTS: Samples of atrial tissue showed the abnormal pathohistological and ultrastructural changes, the accelerated fibrosis, and apoptosis with aging and/or in AF dogs. Compared to the adult group, the expressions of microRNAs-21 and -29 were significantly increased, whereas the expressions of microRNAs-1 and -133 showed obvious downregulation tendency in the aged group. Compared to the aged group, the expressions of microRNAs-1, -21, and -29 was significantly increased in the old group in AF; contrastingly, the expressions of microRNA-133 showed obvious downregulation tendency. CONCLUSION: These multiple aberrantly expressed microRNAs may be responsible for modulating the transition from adaptation to pathological atrial remodeling with aging and/or in AF.

[Outcome and factors affecting left atrial remodeling after percutaneous balloon mitral valvuloplasty in patients with mitral valve stenosis].

OBJECTIVE: To observe the outcome and assess related factors affecting left atrial remodeling after percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral valve stenosis. METHODS: From March 1998 to June 2002, there were 96 mitral valve stenosis patients who underwent PBMV in our hospital. Echocardiographic, 12 leads united electrocardiogram and other clinical datas were collected at preoperation, 1 week after operation, and 4 - 6 years after operation to retrospective analysis. Multiple stepwise regression analysis was used to assess controllable factors of left atrial remodeling. RESULTS: Left atrial diameter reduced from (44.6 +/- 6.6) cm before PBMV to (42.8 +/- 6.5) cm (P > 0.05) 1 week after PBMV and enlarged to (47.2 +/- 5.7)cm (all P < 0.05) at the end of 4 - 6 years follow up post operation. The mitral valve area (MVA) increased from (1.06 +/- 0.32) cm2 before PBMV to (2.02 +/- 0.43) cm2 1 week after PBMV and (1.98 +/- 0.36) cm2 4 - 6 years post operation (all P < 0.05). Heart function assessed by NYHA classification improved significantly at 1 week and 4 - 6 years after surgery compared with pre-operation (P < 0.01). Multiple stepwise regression analysis showed that systolic blood pressure at 4 - 6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins score < or = 8, preoperative left atrial diameter were the independent predictive factors of left atrial remodeling at 4 - 6 years after PBMV. CONCLUSIONS: PBMV was an effective therapy option for patients with mitral valve stenosis. Systolic blood pressure at 4 - 6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins < or = 8, preoperative left atrial diameter are the predictive factors of left atrial remodeling after PBMV.