Effects of green tea on lipid profile in overweight and obese women.

The effect of green tea administration on serum lipids' concentrations remains unclear as various investigations, which have explored this topic, have produced conflicting results. Gender might be one of the factors influencing the impact of green tea on the lipid profile. Hence, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of green tea intake on the lipid profile in overweight and obese women. We searched five databases (Web of Science, SCOPUS, Embase, PubMed/Medline, and Google Scholar) using a combination of MeSH and non-MeSH terms. Results were expressed as weighted mean differences (WMDs) and 95% confidence intervals (CIs) and synthesized with a random-effects model. In total, 15 eligible RCTs with 16 arms (1818 participants) were included in the meta-analysis. The combined effect size revealed a significant reduction in total cholesterol (TC) (WMD: -4.45 mg/dl, 95% CI: -6.63, -2.27, P<0.001) and low-density lipoprotein cholesterol (LDL-C) (WMD: -4.49 mg/dl, 95% CI: -7.50 to -1.47, P=0.003) concentrations following green tea supplementation in overweight and/or obese women. In addition, a more pronounced reduction of triglyceride (TG) levels occurred when the baseline TG value was ≥150 mg/dL (WMD: -24.45 mg/dL, 95% CI: -40.63 to -8.26, P=0.003). Moreover, a significant decrease in TG concentrations occurred in RCTs conducted on overweight subjects (BMI: 25-29.99 kg/m2) (WMD: -5.88 mg/dl, 95% CI: -10.76 to -0.99, P=0.01). In the subgroup analyses based on the study population, a notable increase in high-density lipoprotein cholesterol (HDL-C) values was observed in obese individuals (>30 kg/m2) (WMD: 2.63 mg/dl, 95% CI: 0.10 to 5.16, P=0.041). Consumption of green tea causes a reduction in LDL-C and TC concentrations in overweight and obese women. The decline in TG levels was notable particularly in overweight patients with hypertriglyceridemia at baseline. In addition, a significant increase in HDL-C was detected in obese subjects following intake of green tea.

Implantable device measured objective daily physical activity as a predictor of long-term all-cause mortality and cardiac death in patients with age > 75 years and high risk of sudden cardiac death: a cohort study : Physical activity and patients over 75 years old.

BACKGROUND: To study the relationship between objective daily physical activity (PA), as measured by implantable cardioverter defibrillators (ICDs)/cardiac resynchronization therapy defibrillators (CRTDs), and long-term prognoses in patients with age > 75 years at high risk of sudden cardiac death (SCD). METHODS: In total, 133 patients with age > 75 years old (age 79.52 ± 3.68 years) in the SUMMIT study were retrospectively analysed. The major endpoint was all-cause mortality, and the minor endpoint was cardiac death. RESULTS: The mean follow-up time was 57.1 ± 24.2 months (range: from 4 to 96 months). In total, 46 all-cause mortality and 23 cardiac death events occurred. The receiver operating characteristic curve indicated a baseline PA cut-off value of 6.47% (93 min/day) can predict all-cause mortality in patients with age > 75 years, with an area under the curve of 0.670 (95% confidence interval (CI): 0.573-0.767, P = 0.001). The sensitivity was 67.4%, and the specificity was 66.7%. Patients with baseline PA ≤ 6.47% had higher rates of all-cause mortality (51.7% vs 20.5%, P < 0.001) and cardiac death (25.0% vs 11.0%, P = 0.040). The estimated Kaplan-Meier survival curves showed that patients with PA ≤ 6.47% had an increased cumulative incidence of all-cause mortality (Log-rank P < 0.0001) and cardiac death (Log-rank P = 0.0067). Multivariate Cox regression analysis showed that PA ≤ 6.47% was an independent predictor of all-cause mortality (hazard ratio (HR) 3.137, 95% CI: 1.667-5.904, P < 0.001) and cardiac death (HR value 3.345, 95% CI: 1.394-8.028, P = 0.007). CONCLUSIONS: Daily PA of about 1.5 h was associated with lower all-cause mortality and cardiac death risk in patients with age > 75 years and high risk of SCD with ICDs/CRTDs. PA monitoring may aid in long-term management of older patients at high risk of SCD.

Dose-response association of implantable device-measured physical activity with long-term cardiac death and all-cause mortality in patients at high risk of sudden cardiac death: a cohort study.

BACKGROUND: Cardiovascular implantable electronic devices (CIEDs) with physical activity (PA) recording function can continuously and automatically collect patients' long-term PA data. The dose-response association of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRTD)-measured PA with cardiovascular outcomes in patients at high risk of sudden cardiac death (SCD) was investigated. METHODS: In total, 822 patients fulfilling the inclusion criteria were included and divided into three groups according to baseline PA tertiles: tertile 1 (< 8.04%, n = 274), tertile 2 (8.04-13.24%, n = 274), and tertile 3 (> 13.24%, n = 274). The primary endpoint was cardiac death, the secondary endpoint was all-cause mortality. RESULTS: During a mean follow-up of 59.7 ± 22.4 months, cardiac death (18.6% vs 8.8% vs 5.5%, tertiles 1-3, P < 0.001) and all-cause mortality (39.4% vs 20.4% vs 9.9%, tertiles 1-3, P < 0.001) events decreased according to PA tertiles. Compared with patients younger than 60 years old, older patients had a lower average PA level (9.6% vs 12.8%, P < 0.001) but higher rates of cardiac death (13.2% vs 8.1%, P = 0.024) and all-cause mortality (28.4% vs 16.7%, P < 0.001) events. Adjusted multivariate Cox regression analyses showed that a higher tertile of PA was associated with a lower risk of cardiac death (hazard ratio (HR) 0.41, 95% confidence interval (CI): 0.25-0.68, tertile 2 vs tertile 1; HR 0.28, 95% CI: 0.15-0.51, tertile 3 vs tertile 1, P trend < 0.001). Similar results were observed for all-cause mortality. The dose-response curve showed an inverse non-linear pattern, and a significant reduction in endpoint risk was observed at the low-moderate PA level. The HR for cardiac death was reduced by half with 12.32% PA (177 min), and the HR for all-cause mortality was reduced by half with 11.92% PA (172 min). Subgroup analysis results indicated that older adults could benefit from PA and the range for achieving optimal benefits might be lower. CONCLUSIONS: PA monitoring may aid in long-term management of patients at high risk of SCD. More PA will generate better survival benefits, but even low-moderate PA is already good especially for older adults, which is relatively easy to achieve.

Trimethylamine N-oxide as a risk marker for ischemic stroke in patients with atrial fibrillation.

Trimethylamine N-oxide (TMAO) is an independent risk factor of cardiovascular disease. Our objective was to explore the relation between TMAO and ischemic stroke (IS) in patients with atrial fibrillation (AF). A total of 68 patients with AF with IS and 111 ones without IS were enrolled. The plasma levels of TMAO remarkably increased in IS-AF patients (8.25 ± 1.58 µM) compared with patients with AF (2.22 ± 0.09 µM, P < 0.01). The receiver operating characteristic analysis revealed that the best cutoff value of TMAO to predict IS in patients with AF was 3.53 µM with 75.0% sensitivity and 92.8% specificity (area under the curve: 0.917, 95% confidence intervals: 0.877-0.957). Univariate and multivariate logistic regression analysis showed that TMAO was an independent predictor in IS. The level of TMAO was correlated with the CHA2DS2-VASc score. In conclusion, TMAO was an independent predictor of IS, which could potentially refine stroke stratification in patients with AF.

Risk of subsequent ventricular arrhythmia is higher in primary prevention patients with implantable cardioverter defibrillator than in secondary prevention patients.

BACKGROUND: Because of previous ventricular arrhythmia (VA) episodes, patients with implantable cardioverter-defibrillator (ICD) for secondary prevention (SP) are generally considered to have a higher burden of VAs than primary prevention (PP) patients. However, when PP patients experienced VA, the difference in the prognosis of these two patient groups was unknown. METHODS: The clinical characteristics and follow-up data of 835 ICD patients (364 SP patients and 471 PP patients) with home monitoring feature were retrospectively analysed. The incidence rate and risk of subsequent VA and all-cause mortality were compared between PP patients after the first appropriate ICD therapy and SP patients. RESULTS: During a mean follow-up of 44.72 ± 20.87 months, 210 (44.59%) PP patients underwent appropriate ICD therapy. In the Kaplan-Meier survival analysis, the PP patients after appropriate ICD therapy were more prone to VA recurrence and all-cause mortality than SP patients (P<0.001 for both endpoints). The rate of appropriate ICD therapy and all-cause mortality in PP patients after the first appropriate ICD therapy was significantly higher than that in SP patients (for device therapy, 59.46 vs 20.64 patients per 100 patient-years; incidence rate ratio [IRR] 2.880, 95% confidence interval [CI]: 2.305-3.599; P<0.001; for all-cause mortality, 14.08 vs 5.40 deaths per 100 patient-years; IRR 2.607, 95% CI: 1.884-3.606; P<0.001). After propensity score matching for baseline characteristics, the risk of VA recurrence in PP patients with appropriate ICD therapy was still higher than that in SP patients (41.80 vs 19.10 patients per 100 patient-years; IRR 2.491, 95% CI: 1.889-3.287; P<0.001), but all-cause mortality rates were similar between the two groups (12.61 vs 9.33 deaths per 100 patient-years; IRR 1.352, 95% CI: 0.927-1.972; P = 0.117). CONCLUSIONS: Once PP patients undergo appropriate ICD therapy, they will be more prone to VA recurrence and death than SP patients.

Prognostic significance of frequent premature ventricular complex early after implantation among patients with implantable cardioverter defibrillator.

BACKGROUND: Premature ventricular complex (PVC) was mainly studied by 24-hour Holter in previous studies. However, the value of long-term Home Monitoring of PVC burden early after ICD implantation is unknown. METHODS: The data of 416 patients with ICD were analyzed. The percentage of days with frequent PVC (≥10/h) within 30th-90th days was calculated as the continuous frequent PVC (CfPVC) percentage. ROC curve of CfPVC percentages was plotted. Kaplan-Meier survival and Cox regression were used to assess the cumulative risks. RESULTS: Based on ROC curves, the cut-off value for the CfPVC percentage was 40%. According to Kaplan-Meier analysis and multivariate Cox regression analysis, CfPVC percentage ≥40% was an independent predictor of higher incidences of VAEs, appropriate ATP, appropriate shocks, and cardiac death. CONCLUSION: A long-term continuous burden of frequent PVC with CfPVC percentage ≥40% can be a predictor of future VAEs, appropriate ATP, appropriate shocks and cardiac death in ICD recipients.

Value of Low-Dose Dobutamine Stress Real-Time Myocardial Contrast Echocardiography in the Diagnosis of Coronary Heart Disease.

To investigate the value of low-dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the diagnosis of coronary heart disease (CHD). A total of 65 hospitalized patients with suspected or confirmed CHD were detected by RT-MCE combined with low-dose dobutamine stress (0.84 mg/kg). Perfusion curves were quantitatively analyzed using QLAB software. Peak intensity (A), slope of curves (ß), and perfusion (A × ß) were also calculated. Based on the results of coronary angiography, patients were divided into no obvious stenosis group (<50%), mild stenosis group (50%-74%), moderate stenosis group (75%-89%), and severe stenosis group (≥90%). The A, ß, and A × ß values before and after low-dose dobutamine stress of each group were compared. In the basal state and after low-dose dobutamine stress, the A, ß, and A × ß values significantly decreased as the stenosis degree of the myocardial segments increased. The same variation tendency was also found in the A, ß, and A × ß reserve values, and there was significant difference in these reserve values between moderate and severe stenosis groups and no obvious stenosis and mild stenosis groups. Collateral circulation had marked effects on the values of myocardial perfusion parameters and their reserve values, especially in the segments with severe stenosis. Low-dose dobutamine stress RT-MCE can be a sensitive method for clinical diagnosis and risk assessment of CHD and may provide a basis for further treatment of CHD.

Combined myocardial deformation to predict cardiac resynchronization therapy response in nonischemic cardiomyopathy.

BACKGROUND: 20-30% of patients do not benefit from cardiac resynchronization therapy (CRT) when the established selection criteria were applied. We hypothesized that a combined assessment of mechanical dyssynchrony, myocardial deformation, and diastolic function would identify patients who would benefit most from CRT. METHOD: In 36 CRT patients, clinical evaluation and echocardiography were performed before and after CRT. Patients were classified into three subgroups according to their amount of response: echocardiographic responders, clinical responders, and nonresponders. Radial dyssynchrony and left ventricular (LV) global longitudinal, radial, and circumferential peak strain was assessed by speckle-tracking image. Diastolic function was quantified by conventional echocardiography. RESULT: In addition to left bundle branch block, nonspecific intraventricular conduction disturbance with intraventricular dyssynchrony could also improve LV remodeling. Echocardiographic responders had better global longitudinal strain, global circumferential peak strain, and global radial strain at baseline which significantly increased at 12-month follow-up. An improvement in estimates of LV filling pressure and a decrease in mitral regurgitation and left atrial dimensions were observed only in echocardiographic responders to CRT. Patients with clinical but without echocardiographic response showed a significant improvement in atrioventricular (AV) synchrony and a nonsignificant improvement in other parameters. The nonresponder group did not improve the AV and intraventricular dyssynchrony. CRT could not improve restrictive filling pattern with normal filling time. Overall, those patients with AV and intraventricular dyssynchrony and those with best contractile function and short diastolic filling time of restrictive filling pattern at baseline demonstrated the greatest benefit from CRT. CONCLUSIONS: Mechanical dyssynchrony, contractile function, and filling pattern are important determinants of the benefits in CRT.

Postoperative Assessment of Myocardial Function and Microcirculation in Patients with Acute Coronary Syndrome by Myocardial Contrast Echocardiography.

BACKGROUND Postoperative myocardial function and microcirculation of acute coronary syndrome (ACS) was assessed by myocardial contrast echocardiography (MCE). MATERIAL AND METHODS Eighty-nine ACS patients treated with percutaneous coronary intervention (PCI) were detected by MCE and two-dimensional ultrasonography before and a month later after PCI respectively. Their myocardial perfusion was evaluated by myocardial contrast score (MSC) and contrast score index (CSI); cross-sectional area of microvessel (A), average myocardial microvascular impairment (ß), and myocardial blood flow (MBF) were analyzed by cardiac ultrasound quantitative analysis (CUSQ), and fractional flow reserve (FFR) change was observed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), and left ventricular end-systolic dimension (LVESD) were observed; the index of microcirculatory resistance (IMR), FFR, and coronary flow reserve (CFR) were detected to evaluate coronary microcirculation. RESULTS None of the 89 patients experienced no-reflow. Patients with normal myocardial perfusion mostly had normal or slightly decreased ventricular wall motion after PCI. A month after the operation, there was an increase in A, ß, MBF, LVEF, E/A, IMR, FFR, and CFR (all P<0.05), while LVEDD, LVESD, diastolic gallop A peak, E/Ea, E/Ea×S, and Tei decreased (all P<0.05). LVEF and IMR were in positive correlations with A. LVEF, IMR, FFR and CFR were positively correlated with b and MBF (both r>0, P<0.05), while E/Ea×Sa and Tei were negatively correlated with b and MBF (r<0, P<0.05). CONCLUSIONS MCE can safely assess post-PCI myocardial function and microcirculation of ASC.

Ginkgo biloba extract and ginkgolide antiarrhythmic potential by targeting hERG and ICa-L channel.

We investigated the effects of Ginkgo biloba extract (GBE) and ginkgolide (GLD) on human ether-a-go-go-related gene (hERG)-encoded K(+) channels and its underlying mechanisms in the hERG-HEK293 cell line by determining GBE- and GLD-induced changes in action potential duration (APD), L-type calcium currents (ICa-L), and the intracellular calcium concentration ([Ca(2+)]i) in guinea-pig ventricular myocytes. hERG currents, APD and ICa-L were recorded using the whole-cell patch clamp technique, the [Ca(2+)]i was examined by an immunofluorescence experiment. In the present study, we found that a low concentration of GBE (0.005 mg/ml) increased hERG currents, but the high concentration of GBE (from 0.05 to 0.25 mg/ml) reduced hERG currents. GLD reduced hERG currents in a concentration-dependent manner (from 0.005 to 0.25 mg/ml). Both GBE and GLD altered kinetics of the hERG channel. GBE accelerated the activation of hERG channels without changing the inactivation curve, but reduced the time constant of inactivation; GLD did not shift the activation or the inactivation curve, but only reduced the time constant of inactivation. Both GBE and GLD shortened the APD, inhibited the ICa-L currents, and decreased the [Ca(2+)]i in isolated guinea-pig ventricular myocytes. The results indicate that GBE and GLD can prevent ischemic arrhythmias and have an antiarrhythmic effect potential via inhibition of IKr and ICa-L currents.

Social determinants of health and hypertension in women compared with men in the United States: An analysis of the NHANES study.

BACKGROUND: Social determinants of health (SDH) reflecting social deprivation have been developed for population health management. There is a paucity of data on the prevalence of SDH and its associations with prevalent hypertension in women compared with men. METHODS: A total of 49 791 participants aged over 20 years from the 1999-2018 National Health and Nutrition Examination Surveys, were included. Information on the SDH, including race/ethnicity, education level, family income, housing, marriage status, employment, were collected. We calculated the prevalence ratio (PR) for each adverse SDH with prevalent hypertension and uncontrolled hypertension by using Cox regression with equal times of follow-up assigned to all individuals with adjustment for age, diabetes, taking lipid-lowering medication, and health behaviors. The population-attributable fractions (PAF) of the SDH were also assessed. RESULTS: A lower proportion of low education attainment was observed in women than men (women: 16.8% vs. men: 17.9%, p = .003), but women had higher proportions of low family income (15.3% vs. 12.5%, p < .001), unmarried state (47.3% vs. 40.9%, p < .001), and unemployment (22.7% vs. 10.7%, p < .001). All the SDH was significantly associated with hypertension in women. There were significant dose-response associations between the numbers of adverse SDH with hypertension. The total PAF of SDH for prevalent hypertension was greater in women (22.2%) than in men (13.9%). CONCLUSIONS: The widely influential SDH is associated with prevalent hypertension and uncontrolled hypertension. To improve hypertension management, health resources should prioritize socioeconomically disadvantaged groups considering gender differences.

Sex Differences in the Relationship between Abdominal Obesity and Cardiovascular Death in Elderly Patients with Permanent Pacemakers Implantation: A Retrospective Cohort Study.

Objectives: This study aims to investigate the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs). Methods: This is a retrospective cohort study that enrolled patients who underwent PPM implantation in Fuwai Hospital from May 2010 to April 2014, according to the BIOTRONIK Home Monitoring database. The WC was treated as sex-specific quartiles, and patients were divided into three groups according to body mass index (BMI): normal (≤22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (≥25 kg/m2). Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for cardiovascular death according to WC and BMI in patients. Results: 492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men (n = 271)). Data showed that after a mean follow-up 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. Men in the third quartile of WC had an HR of 10.67 (Model 4, 95% CI: 1.00-115.21, p trend = 0.04) for cardiovascular death. However, the association disappeared in female patients (Model 4, HR = 3.99, 95% CI: 0.37-42.87, p trend = 0.25). There was no association between BMI and cardiovascular death or all-cause mortality in both male and female patients. Conclusions: Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs, and this relationship was only in male patients.

Absence of Obesity Paradox in All-Cause Mortality Among Chinese Patients With an Implantable Cardioverter Defibrillator: A Multicenter Cohort Study.

Background: The results of studies on the obesity paradox in all-cause mortality are inconsistent in patients equipped with an implantable cardioverter-defibrillator (ICD). There is a lack of relevant studies on Chinese populations with large sample size. This study aimed to investigate whether the obesity paradox in all-cause mortality is present among the Chinese population with an ICD. Methods: We conducted a retrospective analysis of multicenter data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted Patients (SUMMIT) registry in China. The outcome was all-cause mortality. The Kaplan-Meier curves, Cox proportional hazards models, and smooth curve fitting were used to investigate the association between body mass index (BMI) and all-cause mortality. Results: After inclusion and exclusion criteria, 970 patients with an ICD were enrolled. After a median follow-up of 5 years (interquartile, 4.1-6.0 years), in 213 (22.0%) patients occurred all-cause mortality. According to the Kaplan-Meier curves and multivariate Cox proportional hazards models, BMI had no significant impact on all-cause mortality, whether as a continuous variable or a categorical variable classified by various BMI categorization criteria. The fully adjusted smoothed curve fit showed a linear relationship between BMI and all-cause mortality (p-value of 0.14 for the non-linearity test), with the curve showing no statistically significant association between BMI and all-cause mortality [per 1 kg/m2 increase in BMI, hazard ratio (HR) 0.97, 95% CI 0.93-1.02, p = 0.2644]. Conclusions: The obesity paradox in all-cause mortality was absent in the Chinese patients with an ICD. Prospective studies are needed to further explore this phenomenon.

Increased Susceptibility of Atrial Fibrillation Induced by Hyperuricemia in Rats: Mechanisms and Implications.

High levels of serum uric acid is closely associated with atrial fibrillation (AF); nonetheless, the detailed mechanisms remain unknown. Therefore, this work examined the intricate mechanisms of AF triggered by hyperuricemia and the impact of the uricosuric agent benzbromarone on atrial remodeling in hyperuricemic rats. After adjusting baseline serum uric acid levels, a total of 28 healthy male adult Sprague Dawley rats were randomly divided into 4 groups, namely, control (CTR), hyperuricemia (oxonic acid potassium salt, OXO) and benzbromarone (+ BBR), and OXO withdrawal groups. Primary rat cardiomyocytes were cultured with uric acid for 24 h to investigate the direct influence of uric acid on cardiomyocytes. Results revealed that AF vulnerability and AF duration were dramatically greater in hyperuricemic rats (OXO group), while the atrial effective refractory periods (AERPs) were significantly shorter. Meanwhile, BBR treatment and withdrawal of 2% OXO administration remarkably reduced AF inducibility and shortened AF duration. Moreover, abnormal morphology of atrial myocytes, atrial fibrosis, apoptosis, and substantial sympathetic nerve sprouting were observed in hyperuricemic rats. Apoptosis and fibrosis of atria were partly mediated by caspase-3, BAX, TGF-ß1, and α-smooth muscle actin. Uric acid significantly induced primary rat cardiomyocyte apoptosis and fibrosis in vitro. Also, we found that sympathetic nerve sprouting was markedly upregulated in the atria of hyperuricemia rats, and was restored by BRB or absence of OXO administration. In summary, our study confirmed that AF induced by hyperuricemic rats occurred primarily via induction of atrial remodeling, thereby providing a novel potential treatment approach for hyperuricemia-related AF.

The correlation between plasma trimethylamine N-oxide level and heart failure classification in northern Chinese patients.

BACKGROUND: Trimethylamine N-oxide (TMAO) has been identified as a new biomarker of cardiovascular disease. Our aim was to evaluate the plasma levels of TMAO in patients with or without heart failure (HF), and to indicate the correlation between plasma TMAO level and HF classification in northern Chinese patients. METHODS: A total of 112 control participants and 184 HF patients participated in this study. Plasma levels of TMAO and N-terminal probrain natriuretic peptide (NT-proBNP) in all participants were examined and analyzed. RESULTS: The plasma TMAO levels were remarkably higher in HF patients than that in control participants (7.0±0.6 vs. 1.5±0.1 µmol/L; P<0.01). In addition, the plasma TMAO levels of significantly increased from NYHA II to NYHA IV group (3.5±0.9, 6.0±0.8 and 8.1±1.0 µmol/L, respectively). The receiver operating characteristic analysis (ROC) showed that area under the curve (AUC) of TMAO was 0.881 (P<0.01). Furthermore, the AUC value for TMAO was 0.857 (95% CI: 0.674-1.000; P<0.01), 0.845 (95% CI: 0.778-0.911; P<0.01) and 0.914 (95% CI: 0.872-0.956; P<0.01) in NYHA II, NYHA III and NYHA IV groups, respectively. Univariate and multivariate logistic regression analysis indicated that TMAO was an independent risk factor for HF in patients. The level of TMAO was positively correlated with NT-proBNP. However, the diagnostic ability of TMAO was lower than that of NT-proBNP. CONCLUSIONS: TMAO was an independent predictor of HF, moreover, the TMAO levels were highly associated with HF classification in northern Chinese patients.

Association of the Obesity Paradox With Objective Physical Activity in Patients at High Risk of Sudden Cardiac Death.

OBJECTIVE: To investigate the obesity paradox and its interrelationship with objective physical activity (PA) in patients at high risk of sudden cardiac death. METHODS: A total of 782 patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators in the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-Implantable Patients registry were retrospectively analyzed and grouped by body mass index (BMI) (kg/m2): normal weight (18.5 ≤ BMI < 25) and overweight or class I obesity (25 ≤ BMI < 35). PA was measured with home monitoring and categorized into 4 groups (Q1-Q4) by the baseline quartiles. The main endpoint was all-cause mortality. RESULTS: During a mean follow-up period of 59.9 ±â€…21.9 months, 182 all-cause mortality events occurred. Mortality tended to be lower in overweight and obesity patients (18.9% vs 25.1%, P = 0.061) and decreased by PA quartiles (44.1% vs 22.6% vs 15.3% vs 11.2%, Q1-Q4, P < 0.001). Multivariate Cox analysis indicated BMI (hazard ratio, 0.918; 95% confidence interval, 0.866-0.974; P = 0.004) and PA (0.436, 0.301-0.631, Q2 vs Q1; 0.280, 0.181-0.431, Q3 vs Q1; 0.257, 0.158-0.419, Q4 vs Q1; P < 0.001 for all) were associated with reduced risk. The obesity paradox was significant in the total cohort (log rank P = 0.049) and low PA group (log rank P = 0.010), but disappeared in the high PA group (log rank P = 0.692). Dose-response curves showed a significant reduction in risk with low-moderate PA, and the pattern varied between different BMI groups. CONCLUSIONS: The obesity paradox only persisted in physically inactive patients. PA might be related to the development of the obesity paradox.

Non-linear Association Between Body Mass Index and Ventricular Tachycardia/Ventricular Fibrillation in Patients With an Implantable Cardioverter-Defibrillator or Cardiac Resynchronization Therapy Defibrillator: A Multicenter Cohort Study.

Background: Results from studies on the effects of obesity on sudden cardiac death (SCD) or ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with an implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) are inconsistent. Our study aimed to explore the impact of BMI on VT/VF in patients with an ICD/CRT-D. Methods: We retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted Patients in China. Nine hundred and seventy ICD/CRT-D patients were enrolled. The outcome was the first occurrence of VT/VF requiring appropriate ICD/CRT-D therapy. A general linear model and general additive model were used to assess the relationship between BMI and VT/VF. Results: After a median follow-up of 5.17 years, 352 (36.3%) patients experienced VT/VF requiring appropriate ICD/CRT-D therapy. BMI, whether as a continuous variable or a categorical variable classified by various BMI classification criteria, had no significant effect on VT/VF according to a multivariable Cox proportional hazards model with adjustment for potential confounders. However, a non-linear association between BMI and VT/VF was identified using a cubic spline function model and smooth curve fitting. The inflection point for the curve was found at a BMI level of 23 kg/m2. The hazard ratios (95% confidence intervals) for VT/VF were 1.12 (1.01-1.24) and 0.96 (0.90-1.02) to the left and right of the inflection point, respectively. Conclusions: BMI is related to VT/VF in a non-linear manner in patients with an ICD/CRT-D. Our research suggests a complicated role of BMI in VT/VF with different impacts at different ranges.

Predictive value of rapid-rate non-sustained ventricular tachycardia in the occurrence of appropriate implantable cardioverter-defibrillator therapy.

PURPOSE: Rapid-rate non-sustained ventricular tachycardia (RR-NSVT) that meets detection criteria but terminates itself before the delivery of implantable cardioverter-defibrillator (ICD) therapy is not rare in routine ICD interrogation. Whether sustained ventricular tachycardia/fibrillation will occur in a short time after RR-NSVT has not been fully elucidated. METHODS: Clinical features and follow-up data of 828 ICD patients with home monitoring were retrospectively collected. RR-NSVT characteristics and time interval between the first episode of RR-NSVT and subsequent appropriate ICD therapy were analyzed. RESULTS: During a mean follow-up of 44.75 ± 20.87 months, 335 episodes of RR-NSVT were documented in 145 patients. A total of 119 patients had both RR-NSVT and appropriate ICD therapy. In multivariate COX regression models, RR-NSVT was an independent predictor of appropriate ICD therapy (HR 7.599, 95%CI 5.926-9.745, P < 0.001), appropriate shock (HR 6.222, 95%CI 4.667-8.294, P < 0.001), and all-cause mortality (HR 2.156, 95%CI 1.499-3.099, P < 0.001). Appropriate ICD therapy was administered after the first RR-NSVT episode in 101 patients, with a median interval of 21 days. Compared to RR-NSVT with appropriate ICD therapy occurring beyond 21 days, RR-NSVT within 21 days prior to appropriate ICD therapy had a longer median duration time (14 s vs. 12 s, P = 0.013), but without significant difference in mean RR interval at initial detection and mean RR interval after episode termination. CONCLUSIONS: Rapid-rate non-sustained VT was an independent predictor of appropriate ICD therapy and all-cause mortality. The presence of RR-NSVT should be considered a possible herald of more serious cardiac events in ICD patients.

Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator.

BACKGROUND: Previous studies have reported inconsistent results on the relationship between body mass index (BMI) and clinical outcomes in implantable cardioverter defibrillator (ICD) patients. Additionally, research on ICD patients with nonischemic cardiomyopathy (NICM) is lacking. HYPOTHESIS: This study aimed to investigate the impact of BMI on mortality and ventricular arrhythmias (VAs) in NICM patients with an ICD. METHODS: This study retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-implanted patients (SUMMIT) in China. Four hundred and eighty NICM patients with an ICD having BMI data were enrolled. Patients were divided into two groups: underweight and normal range group (BMI < 24 kg/m2 ), overweight and obese group (BMI≥24 kg/m2 ). The primary endpoint was all-cause mortality. The secondary endpoint was the first occurrence of VAs requiring appropriate ICD therapy or shock. RESULTS: During a median follow-up of 61 (1-95) months, 70 patients (14.6%) died, 173 patients (36%) experienced VAs requiring appropriate ICD therapy, and 112 patients (23.3%) were treated with ICD shock. Multivariate Cox regression modeling indicated a decreased mortality risk in the overweight and obese group compared with the underweight and normal range group (hazard ratio = 0.44, 95% confidence interval 0.26-0.77, P = .003). However, the risk of VAs was similar in both groups in univariate and multivariate Cox models. CONCLUSIONS: Compared with underweight and normal weight, overweight and obesity are protective against mortality but have only a neutral impact on VAs risk in NICM patients with an ICD.

Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators.

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality. Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively. Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA