Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease.

OBJECTIVES: Contrast-induced nephropathy (CIN) has not been systematically studied in high-risk patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHODS: We prospectively observed 515 consecutive patients with CKD undergoing PCI. Patients were divided into three groups: patients who underwent attempted PCI for CTO (group A, n = 85), patients who did not receive PCI for CTO (group B, n = 45) and patients without CTO (group C, n = 385). RESULTS: CIN developed in 55 patients (10.68 %). Group A patients received a larger CM dose than group B or group C (p = 0.024). The intravenous hydration volume, age and CIN Mehran score were not significantly different between the three groups. The incidence of CIN was 9.4 % for group A, 6.7 % for group B and 11.4 % for group C (p = 0.344). In-hospital mortality and required renal replacement therapy (p = 0.325) were not significantly different between the groups. Multivariate analysis showed that after adjusting for potential confounding factors, the odds ratio for CIN was 1.03 (p = 0.944) for group A and 0.64 for group B (p = 0.489) compared to group C. CONCLUSIONS: Attempts to achieve recanalization of CTO in patients with CKD might not increase the risk of CIN if appropriate preventative measures are taken. KEY POINTS: • Contrast-induced nephropathy can increase morbidity and mortality • Chronic kidney disease patients are at the greatest risk of CIN • Patients with CKD undergoing CTO-PCI are common • Incidence of CIN has not been reported in CKD patients • CTO-PCI in CKD patients might not increase the risk of CIN.

[Analysis of coronary rotational atherectomy related complications].

OBJECTIVE: To analysis the complications of coronary rotational atherectomy and evaluate the safety of this procedure. METHOD: A total of 250 rotational atherectomy cases from April 1994 to February 2012 were screened retrospectively and 22 cases patients (8.8%) with rotational atherectomy-related complications were included in this analysis. RESULTS: Among these 22 patients, all lesions were either type B2 or C calcified lesions as evidenced by coronary angiography. After the rotation procedure, there were seven cases (2.8%) with slow reflow and two (0.8%) cases with no reflow. Seven cases (2.8%) developed severe coronary spasm and two cases (0.8%) had sinus bradycardia. Coronary dissection occurred in two cases (0.8%), while one case (0.4%) had coronary perforation and cardiac tamponade. Burr entrapment happened in one case (0.4%). There was no malignant arrhythmia, acute myocardial infarction, emergent coronary artery bypass graft or device related death during and post procedure. Comparison with baseline data, the concentration of CK-MB elevated significantly after the rotational atherectomy [(31.2 ± 4.8) mmol/L vs. (11.4 ± 6.5) mmol/L, P < 0.05]. CONCLUSION: Coronary rotational atherectomy is safe and procedure-related complications are rare.

Contrast medium volume to creatinine clearance ratio: a predictor of contrast-induced nephropathy in the first 72 hours following percutaneous coronary intervention.

OBJECTIVES: To investigate the predictive value of the contrast media volume to creatinine clearance (V/CrCl) ratio for the risk of contrast-induced nephropathy (CIN) (i.e., within 48-72 hr) and to determine a relatively safe V/CrCl cut-off value to avoid CIN in patients following percutaneous coronary intervention (PCI). BACKGROUND: The V/CrCl ratio is a pharmacokinetic risk factor for an early abnormal increase in serum creatinine (i.e., within 24 hr) after PCI. METHODS: V/CrCl ratios were obtained from 1,140 consecutive consenting patients after unselective PCI. Receiver-operator characteristic (ROC) curves were used to identify the optimal sensitivity for the observed range of V/CrCl. The predictive value of V/CrCl for the risk of CIN was assessed using multivariate logistic regression. RESULTS: Fifty-five (4.8%) patients out of 1,140 developed CIN. There was a significant association between higher V/CrCl ratio values and risk of CIN in the overall population: 1.4%, 1.4%, 5.7%, and 10.9% for quartile 1 (Q1) of the V/CrCl value (<1.56, n = 283), Q2 (1.56-2.27, n = 289), Q3 (2.28-3.42, n = 282), and Q4 (>3.42, n = 285) of contrast, respectively (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.62 was a fair discriminator for CIN (C-statistic 0.73). After adjusting for other known predictors of CIN, V/CrCl ratios > 2.62 remained significantly associated with CIN (odds ratio: 2.20; 95% confidence interval: 1.00-4.81, P < 0.05). CONCLUSION: A V/CrCl ratio > 2.62 was a significant and independent predictor of CIN after PCI in unselected patients.

[MicroRNAs expression in normal and dissected aortic tissue].

OBJECTIVES: To investigate if there is altered microRNAs (miRNAs) expression in aortic dissection (Debakey Type A) and normal aorta tissue. METHODS: Total RNA was exacted from aorta of 5 patients with aortic dissection (AD) and four patients without aortic diseases (NA). miRNAs of the aortic tissues were analyzed by miRNA microarray. Reverse transcription polymerase chain reaction (RT-PCR) was performed to verify the expression of miRNAs in larger sample size (AD = 11 and NA = 9). RESULTS: hsa-miR-146b-5p_st, hsa-miR-19a_st and hsa-miR-505_st were significantly upregulated while hsa-miR-1268_st and hsa-miR-939_st were significantly downregulated [fold change > 2, q-value (%) ≤ 5] in AD group compared with NA group. RT-PCR verified hsa-miR-146b-5p_st miRNAs change in AD group. CONCLUSIONS: Altered miRNAs expression might play an essential role in the pathogenesis of aortic dissection formation and hsa-miR-146b-5p_st might serve as a new diagnosis biomarker of aortic dissection.

[A randomized controlled trial of rapid artificial cardiac pacing in thoracic endovascular aortic repair].

OBJECTIVE: To compare the safety, efficacy and their impact on stent graft positioning between rapid artificial cardiac pacing induced hypotension and sodium nitroprusside induced hypotension during thoracic endovascular aortic repair (TEVAR). METHODS: From September 2007 to February 2009, a randomized controlled trial as approved by the Ethics Committee of our hospital was conducted in 197 patients undergoing elective thoracic endovascular aortic repair of thoracic aortic dissection (n = 175) or aneurysm (n = 22). The patients were randomized into sodium nitroprusside group (n = 98) and rapid artificial cardiac pacing group (n = 99). During the localization and deployment of stent graft, hypotension was induced by intravenous sodium nitroprusside or rapid artificial cardiac pacing. Hemodynamics, landing precision (deviation from planned placement site), duration of procedure, renal function, neurocognitive function, incidence of endoleaks and paraplegia/hemiplegia were compared. RESULTS: Rapid artificial cardiac pacing was conducted without technical difficulty in all 99 patients. The level of hypotension (mm Hg, 1 mm Hg = 0.133 kPa) was most pronounced in the rapid artificial cardiac pacing group (47 ± 5 vs 82 ± 7, P = 0.003. Once rapid pacing ceased, blood pressure recovered more quickly to the preparing levels in the rapid artificial cardiac pacing group [(9 ± 2) s vs (481 ± 107) s, P < 0.01]. And the duration of procedure was also shorter in the rapid artificial cardiac pacing group [(94 ± 16) min vs (103 ± 24) min, P < 0.01]. Moreover, precise positioning and deployment was observed in rapid artificial cardiac pacing group versus to the sodium nitroprusside group (P < 0.01). There was no difference in renal function and neurocognitive function before and after the procedure in both groups. There was no difference in the incidences of endoleaks and paraplegia/hemiplegia between different groups (P > 0.05). CONCLUSION: As compared with sodium nitroprusside, rapid artificial cardiac pacing is safer in thoracic endovascular aortic repair. It shortens the endovascular procedure and enables more precise positioning and deployment of stent graft.

[Two-photon sensors for proton derived from 7-pyridinylbenzo[c] [1,2,5]thiadiazole receptor].

Two new chromophores with carbazole as molecular focal point bearing either one o-pyridine-benzothiadiazole unit or two o-pyridine-benzothiadiazole units at the periphery respectively, named as 2,8-(o-pyridine-benzothiadiazole)-N-ethyl-carbazole (CPTZ1) and 2,8-bis(o-pyridine-benzothiadiazole)-N-ethyl-carbazole (CPTZ2), were synthesized and characterized by IR spectra, 1H NMR spectra and MS. The influence of proton upon one-photon and two-photon fluorescence about these two compounds was discussed. Stern-Volmer equation gives that the S-V constants (k(SV)(1P)) of one-photon fluorescence (1PF) of CPTZ1 and CPTZ2 are 0.04 and 0.10 L mol(-1), respectively; while the k(SV)(2P) of two-photon fluorescence (2PF) of CPTZ1 and CPTZ2 are 0.20 and 0.22 L mol(-1), respectively. Obviously, two-photon (2P) fluorescence detection presented more sensitivity than one-photon (1P) fluorescence response, which exhibits the potential application of two-photon sensor in PH detection.

[Incidence and risk factors of coronary artery disease in elderly patients with abdominal aortic aneurysm].

OBJECTIVE: To explore the prevalence of coronary artery disease and risk factors in patients with abdominal aortic aneurysm (AAA). METHODS: Coronary angiography was performed immediately after abdominal angiography in 70 elderly (> 50 years) consecutive patients with AAA. Medical history and imaging characteristics were evaluated. RESULTS: CAD was diagnosed in 63 patients (90.0%) by coronary angiography: 20 (28.6%) patients with single-vessel disease (SVD), 15(21.4%) with 2VD, 22 (31.4%) with 3VD and 6 (8.6%) with left main disease + 3VD. Multi-variance logistic analysis showed that peripheral disease was the strongest predictor for CAD in AAA patients. CONCLUSION: Coronary angiography should be performed in elderly AAA patients due to the high prevalence of CAD in this patient cohort.

Association of Parenteral Anticoagulation Therapy With Outcomes in Non-ST-Segment Elevation Acute Coronary Syndrome Patients Without Invasive Therapy: Findings from the Improving Care for Cardiovascular Disease in China (CCC) project.

Our previous study showed that parenteral anticoagulation therapy (PACT) in the context of aggressive antiplatelet therapy failed to improve clinical outcomes in patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). However, the role of PACT in patients managed medically remains unknown. This observational cohort study enrolled patients with NSTE-ACS receiving medical therapy from November 2014 to June 2017 in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project. Eligible patients were included in the PACT group and non-PACT group. The primary outcomes were in-hospital all-cause mortality and major bleeding. The secondary outcome included minor bleeding. Among 23,726 patients, 8,845 eligible patients who received medical therapy were enrolled. After adjusting the potential confounders, PACT was not associated with a lower risk of in-hospital all-cause mortality (adjusted odds ratio (OR), 1.25; 95% confidence interval (CI), 0.92-1.71; P = 0.151). Additionally, PACT did not increase the incidence of major bleeding or minor bleeding (major bleeding: adjusted OR, 1.04; 95% CI, 0.80-1.35; P = 0.763; minor bleeding: adjusted OR, 1.27; 95% CI, 0.91-1.75; P = 0.156). The propensity score analysis confirmed the primary analyses. In patients with NSTE-ACS receiving antiplatelet therapy, PACT was not associated with a lower risk of in-hospital all-cause mortality or a higher bleeding risk in patients with NSTE-ACS receiving non-invasive therapies and concurrent antiplatelet strategies. Randomized clinical trials are warranted to reevaluate the safety and efficacy of PACT in all patients with NSTE-ACS who receive noninvasive therapies and current antithrombotic strategies.

Utility of age, creatinine, and ejection fraction score in patients with type B aortic dissection undergoing thoracic endovascular aortic repair.

BACKGROUND: Older age, renal and cardiac dysfunction are predictors of poor outcome in aortic dissection. The aim of this study was to evaluate the association of the age, creatinine and ejection fraction (ACEF) score with adverse events in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). METHODS: The study enrolled 605 patients from January 2010 to July 2015, who were classified into three groups according to the tertiles of ACEF score: Tertile 1 (≤0.77, n = 204), Tertile 2 (0.77-0.96, n = 205) and Tertile 3 (>0.96, n = 196). The association between ACEF, AGEF (age, glomerular filtration rate and ejection fraction) and the updated version of the ACEF (ACEF II) score with adverse events was analyzed. RESULTS: After a median 3.4 years follow-up, 63 (10.4%) patients died. Multivariable analysis revealed that ACEF score was independently associated with long-term mortality (adjusted hazard ratio = 3.54; 95% confidence interval, 2.09-6.01; p < 0.001). ACEF, AGEF and ACEF II score had similar predictive ability for both in-hospital and long-term death. The in-hospital mortality (1.5% vs. 1.0% vs. 6.6%, p = 0.001) were significantly higher in Tertile 3. In addition, cumulative long-term mortality in Tertile 3 was significantly higher than that in Tertile 1 and 2 (Log-Rank = 23.74; p < 0.001). CONCLUSION: ACEF score could be served as an useful and relatively simple tool for pre-TEVAR risk stratification in TBAD patients.

Circular RNA circRNA_000203 aggravates cardiac hypertrophy via suppressing miR-26b-5p and miR-140-3p binding to Gata4.

AIMS: Circular RNAs (circRNAs) are involved in gene regulation in a variety of physiological and pathological processes. The present study aimed to investigate the effect of circRNA_000203 on cardiac hypertrophy and the potential mechanisms involved. METHODS AND RESULTS: CircRNA_000203 was found to be up-regulated in the myocardium of Ang-II-infused mice and in the cytoplasma of Ang-II-treated neonatal mouse ventricular cardiomyocytes (NMVCs). Enforced expression of circRNA_000203 enhances cell size and expression of atrial natriuretic peptide and ß-myosin heavy chain in NMVCs. In vivo, heart function was impaired and cardiac hypertrophy was aggravated in Ang-II-infused myocardium-specific circRNA_000203 transgenic mice (Tg-circ203). Mechanistically, we found that circRNA_000203 could specifically sponge miR-26b-5p, -140-3p in NMVCs. Further, dual-luciferase reporter assay showed that miR-26b-5p, -140-3p could interact with 3'-UTRs of Gata4 gene, and circRNA_000203 could block the above interactions. In addition, Gata4 expression is transcriptionally inhibited by miR-26b-5p, -140-3p mimic in NMVCs but enhanced by over-expression of circRNA_000203 in vitro and in vivo. Functionally, miR-26b-5p, -140-3p, and Gata4 siRNA, could reverse the hypertrophic growth in Ang-II-induced NMVCs, as well as eliminate the pro-hypertrophic effect of circRNA_000203 in NMVCs. Furthermore, we demonstrated that NF-κB signalling mediates the up-regulation of circRNA_000203 in NMVCs exposed to Ang-II treatment. CONCLUSIONS: Our data demonstrated that circRNA_000203 exacerbates cardiac hypertrophy via suppressing miR-26b-5p and miR-140-3p leading to enhanced Gata4 levels.

The Smad3-miR-29b/miR-29c axis mediates the protective effect of macrophage migration inhibitory factor against cardiac fibrosis.

Although macrophage migration inhibitory factor (MIF) is known to have antioxidant property, the role of MIF in cardiac fibrosis has not been well understood. We found that MIF was markedly increased in angiotension II (Ang-II)-infused mouse myocardium. Myocardial function was impaired and cardiac fibrosis was aggravated in Mif-knockout (Mif-KO) mice. Functionally, overexpression of MIF and MIF protein could inhibit the expression of fibrosis-associated collagen (Col) 1a1, COL3A1 and α-SMA, and Smad3 activation in mouse cardiac fibroblasts (CFs). Consistently, MIF deficiency could exacerbate the expression of COL1A1, COL3A1 and α-SMA, and Smad3 activation in Ang-II-treated CFs. Interestingly, microRNA-29b-3p (miR-29b-3p) and microRNA-29c-3p (miR-29c-3p) were down-regulated in the myocardium of Ang-II-infused Mif-KO mice but upregulated in CFs with MIF overexpression or by treatment with MIF protein. MiR-29b-3p and miR-29c-3p could suppress the expression of COL1A1, COL3A1 and α-SMA in CFs through targeting the pro-fibrosis genes of transforming growth factor beta-2 (Tgfb2) and matrix metallopeptidase 2 (Mmp2). We further demonstrated that Mif inhibited reactive oxygen species (ROS) generation and Smad3 activation, and rescued the decrease of miR-29b-3p and miR-29c-3p in Ang-II-treated CFs. Smad3 inhibitors, SIS3 and Naringenin, and Smad3 siRNA could reverse the decrease of miR-29b-3p and miR-29c-3p in Ang-II-treated CFs. Taken together, our data demonstrated that the Smad3-miR-29b/miR-29c axis mediates the inhibitory effect of macrophage migration inhibitory factor on cardiac fibrosis.

Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome.

Importance: The association of parenteral anticoagulation therapy with improved outcomes in patients with non-ST-segment elevation acute coronary syndrome was previously established. This benefit has not been evaluated in the era of dual antiplatelet therapy and percutaneous coronary intervention. Objective: To evaluate the association between parenteral anticoagulation therapy and clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Design, Setting, and Participants: This cohort study included 8197 adults who underwent percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome from January 1, 2010, to December 31, 2014, at 5 medical centers in China. Patients receiving parenteral anticoagulation therapy only after percutaneous coronary intervention were excluded. Exposures: Parenteral anticoagulation therapy. Main Outcomes and Measures: The primary outcome was in-hospital all-cause death and in-hospital major bleeding as defined by the Bleeding Academic Research Consortium definition (grades 3-5). Results: Of 6804 patients who met the final criteria, 5104 (75.0%) were male, with a mean (SD) age of 64.2 (10.4) years. The incidence of in-hospital death was not significantly different between the patients who received and did not receive parenteral anticoagulation therapy (0.3% vs 0.1%; P = .13) (adjusted odds ratio, 1.27; 95% CI, 0.38-4.27; P = .70). A similar result was found for myocardial infarction (0.3% vs 0.3%; P = .82) (adjusted odds ratio, 0.77; 95% CI, 0.29-2.07; P = .61). In-hospital major bleeding was more frequent in the parenteral anticoagulation group (2.5% vs 1.0%; P < .001) (adjusted odds ratio, 1.94; 95% CI, 1.24-3.03; P = .004). At a median (interquartile range) follow-up of 2.96 years (1.93-4.46 years), all-cause death was not significantly different between the 2 groups (adjusted hazards ratio, 0.87; 95% CI, 0.71-1.07; P = .19), but the incidence of major bleeding was higher in the parenteral anticoagulation group (adjusted hazards ratio, 1.43; 95% CI, 1.01-2.02; P = .04). The propensity score analysis confirmed these primary analyses. Conclusions and Relevance: In the patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome, parenteral anticoagulation therapy was not associated with a lower risk of all-cause death or myocardial infarction but was significantly associated with a higher risk of major bleeding. These findings raise important safety questions about the current practice of routine parenteral anticoagulation therapy while we await randomized trials of this practice.

[Gender-related difference in patients with aortic dissection from Guangzhou].

OBJECTIVE: To investigate gender-related differences in risk factors, clinical manifestation and outcomes in patients with aortic dissection (AD) from Guangzhou. METHODS: Consecutive patients with AD admitted to our institute over the past 10 years were included in this retrospective analysis. Prevalence of hypertension, smoking, thickness of intraventricular septum and left ventricular posterior wall measured by echocardiography, and outcomes were compared between male and female AD patients. RESULTS: There were more male AD patients than female AD patients (5.33:1) from the 418 patients. Prevalence of hypertension, thickness of intraventricular septum and left ventricular posterior wall were similar in male and female AD patients. Heavy smoking history was 56.5% in males and 13.6% in females (P = 0.000). Acute survival rate in female patients tended to be better than that in male patients. CONCLUSIONS: There were significantly more male AD patients than female AD patients in this cohort. Prevalence of heave smoking in male patients is 3 times higher than that in female population.

[Endovascular repair for patients with DeBakey III aortic dissection].

OBJECTIVE: To investigate the clinical therapeutic effects of endovascular repair for patients with DeBakey III aortic dissection. METHODS: From December 2002 to June 2007, endovascular TALENT stent-graft exclusion was performed in 75 (65 males, mean age 54.4 +/- 12.6 years) patients with DeBakey III aortic dissection (1 young woman due to Ehlers-Danlos syndrome, 2 young men due to primary aldosteronism and trauma respectively). All patients were diagnosed by contrast enhanced computed tomography (CT) or MRI. Stent-grafts were deployed via femoral artery to exclude the tear of dissection. Aortic angiography was performed immediately after procedure. RESULTS: Eighty-one stent-grafts were installed in 75 patients successfully without operation related dissection. Endoleakage immediately after stent-graft deploying was evidenced in 25 patients and disappeared after stent placements (n = 6) or balloon dilation (n = 19). Two patients died from aortic rupture within 2 days after procedure. Iliac artery was torn in a female patient with Ehlers-Danlos syndrome, this patient developed hemorrhagic shock after stent-graft placement and recovered after anti-shock treatments and iliac artery replacement with synthetic artery. During the follow-up of 1 - 24 months, 2 patients (including the woman with Ehlers-Danlos syndrome) suddenly died half a year after procedure. The remaining patients were alive and well. Repeat CT during follow up showed that reduced lumen size and thrombosis in the false lumen. There was no aortic rupture, endoleak and stent migration during the follow-up period except descending aortic dissection distal of the stent-graft in 1 patient 1 year after procedure and the patient were successfully treated surgically without complication. CONCLUSIONS: Endovascular repair is a safe and effective treatment for patients with DeBakey III aortic dissection, suitable for old patients with high risk of surgery. Ehlers-Danlos syndrome should be considered in young DeBakey III aortic dissection patients without hypertension. Further studies are warranted on endovascular repair therapy for artery complication of Ehlers-Danlos syndrome.

[Change trend of clinical characteristics of aortic dissection over 10 years].

OBJECTIVE: To discuss the clinical epidemiology features and change trend of aortic dissection (AD). METHODS: Retrospective analysis of consecutive 339 patients with AD over 10 years in Guangdong Cardiovascular Institution. Hospital records and prognosis were compared between two five-year periods. RESULTS: 339 cases with AD were hospitalized during the past 10 years. The mean age was 55.7 +/- 11.2. The male/female ratio was 4.75 to 1. Hypertension was present in 71.7% of all patients. Heavy smoking history was elicited in 52.2% of all the patients. Type I dissection were identified in 32.3% of all the cases, type II in 5.1%, and type III in 62.6%. In-hospital mortality of acute type A dissection was 35.3%, acute type B dissection 8.0%. In two five-year periods, the total number of cases increased by 165%, among which type I was the fastest, increased by 270%. Changes of mean age and male/female ratio were not significant. For acute AD, changes of prognosis in one year improved, but did not reach statistical significance. CONCLUSIONS: This study provides insight into current regional profiles of AD. The number of hospitalized patients with AD is increasing dramatically. The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers. Limited by sample size, one year prognosis of acute AD dissection improved, but did not reach statistical significance. These data support the urgent need for further improvement in prevention and treatment of AD.

Targeting myocyte-specific enhancer factor 2D contributes to the suppression of cardiac hypertrophic growth by miR-92b-3p in mice.

The role of microRNA-92b-3p (miR-92b-3p) in cardiac hypertrophy was not well illustrated. The present study aimed to investigate the expression and potential target of miR-92b-3p in angiotensin II (Ang-II)-induced mouse cardiac hypertrophy. MiR-92b-3p was markedly decreased in the myocardium of Ang-II-infused mice and of patients with cardiac hypertrophy. However, miR-92b-3p expression was revealed increased in Ang-II-induced neonatal mouse cardiomyocytes. Cardiac hypertrophy was shown attenuated in Ang-II-infused mice received tail vein injection of miR-92b-3p mimic. Moreover, miR-92b-3p inhibited the expression of atrial natriuretic peptide (ANP), skeletal muscle α-actin (ACTA1) and ß-myosin heavy chain (MHC) in Ang-II-induced mouse cardiomyocytes in vitro. Myocyte-specific enhancer factor 2D (MEF2D), which was increased in Ang-II-induced mouse hypertrophic myocardium and cardiomyocytes, was identified as a target gene of miR-92b-3p. Functionally, miR-92b-3p mimic, consistent with MEF2D siRNA, inhibited cell size increase and protein expression of ANP, ACTA1 and ß-MHC in Ang-II-treated mouse cardiomyocytes. Taken together, we demonstrated that MEF2D is a novel target of miR-92b-3p, and attenuation of miR-92b-3p expression may contribute to the increase of MEF2D in cardiac hypertrophy.

Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease.

Percutaneous transluminal renal artery stenting (PTRAS) has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis (ARAS). Whether PTRAS could improve left ventricular hypertrophy (LVH) and reduce adverse events when based on percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD) and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction (HFpEF). A total of 228 patients meeting inclusion criteria were divided into two groups: (1) the HFpEF-I group, with PCI and PTRAS; (2) the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index (LVMI) and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure (SBP) was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.

[Exercise-induced myocardial ischemia in patients with coronary artery ectasia without significant coronary stenosis].

OBJECTIVE: To investigate whether exercise would induce myocardial ischemia in patients with coronary artery ectasia without significant coronary stenosis. METHODS: A total of 41 patients (male 29, female 12) with coronary artery ectasia without significant coronary stenosis, confirmed by selective coronary angiography, were enrolled in the study group. Forty-one patients with normal coronary arteries were in the control group. All the patients received a clinical examination and treadmill exercise before selective coronary angiography. RESULTS: Eighteen patients (43.9%) had typical angina in the study group with respect to two patients in the control group (chi(2)=10.498, P=0.001). In the study group, 32 cases had positive treadmill test with respect to five cases in the control group (chi(2)=35.903, P<0.0001). CONCLUSION: Patients with coronary artery ectasia without significant coronary stenosis could get typical angina. Exercise could induce myocardial ischemia which should be paid attention to.

[Palliative percutaneous transluminal renal angioplasty and stenting in elderly patients for serious coronary heart disease with renal arterial stenosis].

OBJECTIVE: To investigate the feasibility of palliative percutaneous transluminal renal angioplasty (PTRA) and stenting in patients with serious coronary heart disease and renal arterial stenosis. METHODS: Thirty-four (23 male and 11 female) patients with a mean age of 61.0+/-11.8 years (ranging from 55 to 78 years) with serious coronary heart disease and renal arterial stenosis, who were unwilling or not suitable to undergo percutaneous coronary intervention and coronary artery bypass grafting, were enrolled in this study. All the cases underwent PTRA and were followed up for 17-53 months (average 35.0+/-9.3 months). The patients' renal and cardiac functions and left ventricular ejection fraction (LVEF) were measured in transthoracic echocardiography with the score of SF-36 Health Survey recorded. RESULTS: During the follow-up, the weekly incidence of angina pectoris reduced from 14.0+/-3.9 to 6.5+/-3.3 (P<0.01) and LVEF increased from (40.2+/-10.4)% to (45.3+/-7.8)% (P<0.05). The SF-36 scores were significantly improved from 56.5+/-8.0 to 80.1+/-16.8 (P<0.01), with also significant improvement in the subscales of health and daily activity, self-feeling, and general health. CONCLUSION: Palliative PTRA and stenting is feasible and necessary in elderly patients with serious coronary heart disease and renal arterial stenosis when percutaneous coronary intervention or coronary artery bypass graft therapy is not possible.

Decrease of glomerular filtration rate may be attributed to the microcirculation damage in renal artery stenosis.

BACKGROUND: The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS). But the gap between artery stenosis and the glomerular filtration ability is still unclear. METHODS: Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR), respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them. RESULTS: A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR, with strong (r = -0.713, P < 0.001) and moderate (r = -0.580, P < 0.001) correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%), the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = -0.827, P < 0.001) and (r = -0.672, P < 0.001) correlations, respectively. CONCLUSIONS: Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.