Sex-specific differences in the effect of lymphocyte-to-C-reactive protein ratio on subclinical myocardial injury in the general population free from cardiovascular disease.

BACKGROUND AND AIM: The Lymphocyte-to-C-reactive protein ratio (LCR) combines information on immune and inflammatory status. Lymphocytes reflect immune health, while C-reactive protein (CRP) signals systemic inflammation. Some studies have linked LCR with cardiovascular outcomes, suggesting it could help identify at-risk individuals. However, its clinical utility needs further research validation. To investigate the association between lymphocyte-to-C-reactive protein ratio (LCR) and subclinical myocardial injury (SC-MI) in individuals who are free from cardiovascular disease (CVD) within the general population. METHODS AND RESULTS: The study included individuals in the National Health and Nutrition Examination Survey (NHANES) III. SC-MI was defined as having a Cardiac Infarction Injury Score (CIIS) greater than 10 units on a 12-lead electrocardiogram. Logistic regression models were employed to investigate the association between LCR and SC-MI. In total, 5870 individuals were included in the study, among whom 3266 had a history of SC-MI. Compared with the lowest quartile (Q1) in male, the odds ratios (OR) of SC-MI in Q2, Q3, and Q4 were 0.67 (95%CI: 0.53-0.86), 0.66 (95%CI: 0.51-0.84), and 0.70 (95%CI: 0.55-0.89), respectively. The data shows a trend where the OR of SC-MI are lower in higher quartiles of LCR, compared to the lowest quartile, in the male population (P for trend = 0.006). In other words, the likelihood of SC-MI tends to be lower among males with higher LCR values. However, after adjusting for potential confounding variables, the relationship between LCR and SC-MI displays a pattern of an initial decline, followed by a minor upward shift. CONCLUSION: LCR is independently and inversely associated with SC-MI risk in the general population free from CVD. Furthermore, the observed association is exclusive to males, indicating a need for further randomized controlled trials to substantiate the efficacy of implementing LCR reduction as a means of CVD prevention in the male population.

Efficacy and Safety of Left Atrial Appendage Occlusion in Mild Mitral Stenosis Patients with High Bleeding Risk.

Atrial fibrillation (AF) is highly prevalent in patients with mitral stenosis (MS), but the efficacy of left atrial appendage occlusion (LAAO) in these patients remains unclear.The aim of this study was to evaluate the efficacy and safety of LAAO in patients with MS complicated by AF at high risk of bleeding.We recruited patients from September 2015 to September 2018. We compared the 3-year outcomes of LAAO in 21 patients with AF complicated by MS and 42 sex- and age-matched patients with AF without MS.The MS group had more cases of peripheral arterial embolism (28.6% versus 2.4%, P = 0.004), more spontaneous echo contrast (47.6% versus 9.5%, P = 0.001), a larger LAA orifice diameter (P < 0.01), and a slower LAA flow (P < 0.05) than the Non-MS group. The mean size of the selected occluder device was bigger for patients with MS than for patients with Non-MS (29.2 ± 3.7 versus 26.9 ± 3.1 mm, P = 0.014). In the first 45 follow-up days, 2 (9.5%) patients with MS had device-related thrombi (DRT); one of them had transient ischemic attack 24 hours postoperatively. From 45 days to 6 months, one patient in each group had DRT. After 6 months, two patients in the Non-MS group still had residual leaks; one of them had a stroke, with a small DRT. The proportion of dual antiplatelet therapy was higher in the Non-MS group than in the MS group (33.3% versus 4.8%, P = 0.012), but this population had an increased bleeding risk.LAAO is relatively effective and safe for preventing embolic events in patients with MS complicated by AF, at high risk of bleeding.

The relationship between C-reactive protein to lymphocyte ratio and the prevalence of myocardial infarction in US adults: A cross-sectional study.

Objective: C-reactive protein to lymphocyte ratio (CLR) has been identified as a novel inflammatory biomarker. However, the role of CLR in myocardial infarction is unclear. Thus, this study designs to investigate the association of CLR with the prevalence of myocardial infarction in a large multiracial population in the United States. Methods: Participants from the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 Pre-pandemic were included in this cross-sectional study. Multivariable regression and subgroup analyses, controlling for demographic variables, were performed to examine the association between CLR and its quintiles and myocardial infarction. A smooth curve fitting was used to model the non-linear relationship between them. Results: A total of 12,615 participants aged ≥18 years were recruited, of whom 609 (4.83%) self-reported a history of myocardial infarction. Compared to those in the lowest quartile of ln-transformed CLR (Q1), the myocardial infarction risks for subjects in Q2, Q3, and Q4 were 1.64, 1.71, and 1.79 times, respectively. Obvious upward trends were observed when ln-transformed CLR increased (P for trend <0.01). In continuous analyses, the fully adjusted odds ratios (OR) for myocardial infarction prevalence per ln-transformed increment in CLR was 1.46 (95% CI: 1.16-1.84, P < 0.01). Furthermore, a linear association was detected for ln-transformed CLR with the risk of myocardial infarction. Interaction test showed that the effect of CLR on myocardial infarction was significantly affected by age (P for interaction = 0.04). Conclusions: Data from a large, cross-sectional cohort program show that CLR is positively associated with myocardial infarction prevalence. Our findings highlight that CLR may be a novel inflammation warning biomarker for myocardial infarction.

Association of the systemic immune-inflammation index with all-cause mortality in patients with arteriosclerotic cardiovascular disease.

Objective: Systemic immune-inflammation index (SII), derived from blood cell counts of circulating platelets, neutrophils, and lymphocytes, has been identified as a novel inflammatory and prognostic marker. However, the clinical value of SII in patients with arteriosclerotic cardiovascular disease (ASCVD) had not been further explored. Thus, this study is designed to explore the associations of SII with mortality in ASCVD individuals. Methods: All individuals with ASCVD aged ≥20 years were included from the National Health and Nutritional Examination Surveys (NHANES) 2005-2014 and followed for survival until 31 December 2019. Multivariable Cox analysis investigated the associations between SII, evaluated as a continuous variable with splines, as categorical ones (quartiles), and the all-cause death. To demonstrate the association between SII and mortality, subgroup analysis, restricted cubic spline along with piecewise linear regression were also conducted. Results: A total of 2,595 participants (57.8% men) were included. During a median of 7.7 years of follow-up, 1,122 deaths due to all-cause were recorded. After adjusting for multiple confounders, when compared with the patients in quartile 1 (SII ln transform), those in quartile 4 had a 46% increased risk for all-cause death [hazard ratio (HR) = 1.46, 95% confidence interval (CI) = 1.22-1.75]. As a continuous variable, each unit of raised ln-SII was associated with a 24% increased risk of all-cause death (HR = 1.24, 95% CI = 1.10-1.38). In the restricted cubic spline regression model, the relationship between ln-SII and all-cause death was non-linear. The cutoff value of ln-SII for mortality was 6.57 and those with a higher than the threshold point had a 1.25-fold risk of mortality. No significant difference was noted below the threshold points. Conclusion: An association was detected between the baseline ln-SII and all-cause mortality in a United States ASCVD population. Increased SII is associated with poor survival in individuals with ASCVD.

An Inverse Correlation between the Atherogenic Index of Plasma and Heart Failure: An Analysis of the National Health and Nutrition Examination Survey 2017-March 2020 Pre-Pandemic Data.

Aims: The atherogenic index of plasma (AIP) is associated with cardiovascular diseases. Nevertheless, limited studies have investigated the association between AIP and the risk of heart failure (HF) in the general population. This study aimed to explore the association between AIP and HF risk using a large-scale population dataset from the National Health and Nutrition Examination Survey (NHANES) 2017−March 2020 Pre-pandemic data. Methods: A total of 5598 individuals were included in the analysis of the association between AIP and HF from the NHANES database. The relationship between AIP and HF was examined using multivariate logistic regression and smooth curve fitting. An association between the two was detected based on the odds ratios (ORs) and 95% confidence intervals (CIs). Results: The overall prevalence of HF among the 5598 participants analyzed was 3.21%. Compared with individuals in the lowest quartile of AIP, participants in the higher quartiles showed a significantly reduced probability of HF. Smooth curve fitting analysis revealed a linear association between AIP and HF. Compared with individuals in Q1 of the AIP, participants in Q2 (OR = 0.38, 95% CI = 0.2−0.72, p = 0.0033), Q3 (OR = 0.24, 95% CI = 0.12−0.48, p < 0.0001), and Q4 (OR = 0.32, 95% CI = 0.14−0.74, p = 0.0075) had a significantly decreased risk of HF after adjusting for other risk factors. Analysis of subgroup strata revealed that AIP may interact with age and statin use (p for interaction = 0.012 and 0.0022, respectively). Conclusion: Our results suggest that a high AIP value is negatively correlated with HF prevalence. The AIP may be an effective method for identifying individuals at a high risk of HF.

Transjugular Approach to Closure of Patent Foramen Ovale Under the Guidance of Fluoroscopy and Transthoracic Echocardiography: A Case Report.

Background: We describe a rare case of patent foramen ovale (PFO) associated stroke in a patient with pulmonary embolism, inferior vena cava thrombosis and undergoing filter implantation who successfully underwent PFO closure using the right internal jugular venous approach. Case Summary: This is a rare case of a 42-year-old patient who presented with stroke and pulmonary embolism and was diagnosed with a PFO, inferior vena cava thrombosis and underwent filter implantation. The patient suffered from stroke and pulmonary embolism successively; that is, embolic events occurred in both the arterial and venous systems. Transesophageal echocardiography (TEE) showed a PFO with an atrial septal aneurysm (ASA), which we considered a "pathological" PFO. Due to the obstructive nature of the inferior vena cava approach, we successfully performed PFO closure via the right internal jugular venous approach under the guidance of X-ray and transthoracic echocardiography (TTE). Discussion: The right jugular venous approach provides a simple technical solution for patients who require PFO closure when femoral venous access is unavailable, which can be performed under X-ray and TTE guidance.

Adults with current asthma but not former asthma have higher all-cause and cardiovascular mortality: a population-based prospective cohort study.

Higher mortality in asthmatics has been shown previously. However, evidence on different asthma phenotypes on long-term mortality risk is limited. The aim was to evaluate the impact of asthma phenotypes on mortality in general population. Data from the National Health and Nutrition Examination Survey from 2001-2002 to 2013-2014 linked mortality files through December 31, 2015, were used (N = 37,015). Cox proportional hazards regression was used to estimate the risk of all-cause and cause-specific mortality adjusting for sociodemographic characteristics, smoking, body mass index, and chronic conditions. During the mean follow-up time of 7.5 years, 4326 participants died from a variety of causes. Current asthma, but not former asthma was associated with increased all-cause mortality (current asthma: HR = 1.37; 95% CI 1.20-1.58; Former asthma: HR = 0.93; 95% CI 0.73-1.18); as well as mortality from cardiovascular disease (HRCurrent = 1.41; 95% CI 1.08-1.85) and chronic lower respiratory diseases (HRCurrent = 3.17; 95% CI 1.96-5.14). In addition, we found that the HR for cardiovascular disease (CVD) mortality was slightly greater in people with childhood-onset asthma than those with adult-onset asthma. The HR for chronic lower respiratory diseases (CLRD) mortality was greater in people with adult-onset asthma than those with childhood-onset asthma. However, the differences were not statistically significant. Our study suggested that current asthma but not former asthma was associated with increased all-cause, CLRD and CVD mortality. Future well-designed studies with larger sample are required to demonstrate the association and clarify the potential mechanisms involved.

(Z)-7,4'-dimethoxy-6-hydroxy-aurone-4-O-ß-glucopyranoside attenuates lipoteichoic acid-induced damage in rat cardiomyoblast cells.

OBJECTIVE: Excessive inflammatory responses in the endocardium are related to progression of infectious endocarditis. This study aimed to investigate whether (Z)-7,4'-dimethoxy-6-hydroxy-aurone-4-O-ß-glucopyranoside (DHAG), a compound isolated from the endophytic fungus Penicillium citrinum of Bruguiera gymnorrhiza, could attenuate cell damage caused by lipoteichoic acid (LTA) in embryonic rat heart cells (H9c2). METHODS: LTA-induced cell damage occurred in H9c2 cells and the protective effects of DHAG at different concentrations (1-10 µM) were assessed. Indicators of oxidative stress and inflammatory responses in H9c2 cells were measured. RESULTS: DHAG (1-10 µM) significantly attenuated LTA-induced damage in H9c2 cells, as evidenced by increased cell viability and mitochondrial membrane potential, decreased cytochrome c release and DNA fragmentation, inhibition of caspase-3 and -9 activity, and altered expression of apoptosis-related proteins. DHAG also decreased oxidative stress by increasing protein expression of nuclear factor (erythroid-derived 2)-like 2 (Nrf2). Furthermore, DHAG inhibited inflammatory responses by decreasing protein expression of nuclear factor kappa B (NF-κB) and mitogen-activated protein kinases (MAPKs). CONCLUSION: DHAG exerted protective effects against LTA-induced cell damage, at least partially by decreasing oxidative stress and inhibiting inflammatory responses. Our results provide a scientific rational for developing DHAG as a therapy against infectious endocarditis.

Plasma Macrophage Migration Inhibitor Factor Is Elevated in Response to Myocardial Ischemia.

BACKGROUND: Macrophage migration inhibitory factor (MIF) is a key regulator of inflammatory responses, including in the heart. Plasma MIF is elevated early in the course of acute myocardial infarction. In this study, we hypothesized that plasma MIF may also be increased in acute myocardial ischemia. METHODS AND RESULTS: Patients undergoing cardiac stress test (stress nuclear myocardial perfusion scan or stress echocardiography) were recruited. Twenty-two patients had a stress test indicative of myocardial ischemia and were compared with 62 patients who had a negative stress test. Plasma MIF was measured by ELISA before and after the stress test. MIF was also measured in patients with peripheral arterial occlusive disease before and after exercise causing claudication. Gene and protein expression of MIF was measured in mouse cardiac and skeletal muscle tissue by real-time polymerase chain reaction and western blot, respectively. Plasma MIF was elevated at 5 and 15 minutes after stress (relative to before stress) in patients with a positive test, compared with those with a negative test. In contrast, high-sensitivity troponin T and C-reactive protein were not altered after stress in either group. MIF was not altered after exercise in PAOD patients, despite the occurrence of claudication, suggesting that plasma MIF is not a marker for skeletal muscle ischemia. This may be explained by a lower gene and protein expression of MIF in skeletal muscle than the heart. CONCLUSIONS: Our results suggest that plasma MIF is an early marker for acute myocardial ischemia.

Comparison of the effectiveness and safety of single versus dual occluders for the closure of multiple atrial septal defects.

BACKGROUND: The purpose of this study was to compare the effectiveness and safety of a single vs dual occluders in the treatment of multiple atrial septal defects (ASDs). METHODS: We retrospectively reviewed the records of patients with multiple ASDs treated with single or dual Amplatzer septal occluders from January 2010 to March 2013. Data extracted from the medical records included patient demographic information, ASD sizes, distance between the defects, preprocedure and postprocedure echocardiographic parameters, and treatment-related complications. Treatment success was defined as the occluder stably fixed without shunting, and no effects to other heart structures. RESULTS: Sixty-four patients were included. There were no significant differences between the two groups with respect to age, weight, gender, larger ASD diameter, smaller ASD diameter, and echocardiographic parameters before treatment. Successful closure was achieved in all patients in the single-occluder group regardless of whether the distance between defects was ≥7 mm or <7 mm, and in all patients in the dual-occluder group. Residual shunting after surgery and residual leakage after 1-year follow-up were significantly more common in the dual-occluder group compared with the single-occluder group (residual shunting: 31% vs. 8%, respectively; P=.02 and residual leakage: 19% vs. 2%, respectively; P=.04). No procedure-related complications occurred in either group. CONCLUSIONS: Single and dual occluders are both safe and effective for the repair of multiple ASDs; however, the risk of residual shunt is greater with dual occluders.

Platypnea-orthodeoxia syndrome in a patient with a pre-existing patent foramen ovale successfully treated with an atrial septal occluder.

Platypnea orthodeoxia syndrome is associated with dyspnea and arterial oxygen desaturation accentuated by an upright posture. It can be secondary to an intracardiac shunt. We report a case of platypnea-orthodeoxia syndrome (POS) in a 58-year old male patient who had a pre-existing patent foramen ovale (PFO) and substantial pulmonary pathologies. He was successfully treated by percutaneous transcatheter closure of the PFO. Our case highlights the importance of recognition of this rare syndrome in patients who present with unexplained hypoxia for whom transcatheter closure of the interatrial shunt can be safely carried out.