Asymptomatic atrial fibrillation among hospitalized patients: clinical correlates and in-hospital outcomes in Improving Care for Cardiovascular Disease in China-Atrial Fibrillation.

AIMS: The clinical correlates and outcomes of asymptomatic atrial fibrillation (AF) in hospitalized patients are largely unknown. We aimed to investigate the clinical correlates and in-hospital outcomes of asymptomatic AF in hospitalized Chinese patients. METHODS AND RESULTS: We conducted a cross-sectional registry study of inpatients with AF enrolled in the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation Project between February 2015 and December 2019. We investigated the clinical characteristics of asymptomatic AF and the association between the clinical correlates and the in-hospital outcomes of asymptomatic AF. Asymptomatic and symptomatic AF were defined according to the European Heart Rhythm Association score. Asymptomatic patients were more commonly males (56.3%) and had more comorbidities such as hypertension (57.4%), diabetes mellitus (18.6%), peripheral artery disease (PAD; 2.3%), coronary artery disease (55.5%), previous history of stroke/transient ischaemic attack (TIA; 17.9%), and myocardial infarction (MI; 5.4%); however, they had less prevalent heart failure (9.6%) or left ventricular ejection fractions ≤40% (7.3%). Asymptomatic patients were more often hospitalized with a non-AF diagnosis as the main diagnosis and were more commonly first diagnosed with AF (23.9%) and long-standing persistent/permanent AF (17.0%). The independent determinants of asymptomatic presentation were male sex, long-standing persistent AF/permanent AF, previous history of stroke/TIA, MI, PAD, and previous treatment with anti-platelet drugs. The incidence of in-hospital clinical events such as all-cause death, ischaemic stroke/TIA, and acute coronary syndrome (ACS) was higher in asymptomatic patients than in symptomatic patients, and asymptomatic clinical status was an independent risk factor for in-hospital all-cause death, ischaemic stroke/TIA, and ACS. CONCLUSION: Asymptomatic AF is common among hospitalized patients with AF. Asymptomatic clinical status is associated with male sex, comorbidities, and a higher risk of in-hospital outcomes. The adoption of effective management strategies for patients with AF should not be solely based on clinical symptoms.

Pre-hospital delay in patients with acute myocardial infarction in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project.

OBJECTIVE: To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction (AMI) in China. METHODS: Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. A total of 33,386 patients with AMI admitted to the index hospitals were included in this study. Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes. RESULTS: Of the 33,386 patients with AMI, 70.7% of patients arrived at hospital ≥ 2 h after symptom onset. Old age, female, rural medical insurance, symptom onset at early dawn, and non-use of an ambulance predicted a prolonged pre-hospital delay (all P < 0.05). Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-segment elevation myocardial infarction (STEMI) (all P < 0.05). A pre-hospital delay of ≥ 2 h was associated with an increased risk of mortality [odds ratio (OR) = 1.36, 95% CI: 1.09-1.69, P = 0.006] and major adverse cardiovascular events (OR = 1.22, 95% CI: 1.02-1.47, P = 0.033) in patients with STEMI compared with a pre-hospital delay of < 2 h. CONCLUSIONS: Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China. Our study identifies that patient characteristics, symptom onset time, and type of transportation are associated with pre-hospital delay time, and provides focuses for quality improvement.

Association between rs20456 and rs6930913 of Kinesin-Like Family 6 and Hypertension in a Chinese Cohort.

This study aimed to investigate the relationship between kinesin-like family 6 (KIF6) polymorphisms and hypertension in a northeast Chinese cohort. In this study, two single nucleotide polymorphisms of KIF6 (rs20456 and rs6930913) and their haplotype were analyzed in 382 hypertension patients and 378 controls with SHEsis analysis platform, and the gene-environmental interactions were evaluated with logistic regression analysis. After adjusting for confounding factors, significantly lower risk of hypertension was observed in participants with genotype TC (0.416 (CI 0.299-0.578), p < 0.001) and CC (0.577 (0.389-0.857), p=0.007) of rs20456 compared with TT. For rs6930913, allele T (0.522 (0.386-0.704), p < 0.001), genotype TT (0.325 (0.205-0.515), p < 0.001), and genotype CT (0.513 (0.379-0.693), p < 0.001) were significantly associated with lower risk of hypertension than allele C and CC genotype, respectively. Gene-environment analyses confirmed the significant influence on hypertension by the interactions between genotypes distribution in rs20456 (CT: p=0.036, TT: p=0.022) and smoking status. No interactions were found between smoking and rs6930913, except those with dominant or recessive genetic models (both P s =0.006). There were no interactions between KIF6 and overweight (all P s > 0.05). Haplotype analyses showed that CC (p=0.005) and TC (p=0.001) of rs20456 and rs6930913 were significantly associated with a statistically increased risk of hypertension. The false-positive report probability (FPRP) analysis was used to verify significant findings. In conclusions, KIF6 might affect the susceptibility of hypertension. The allele C (rs20456) and allele T (rs690913) were inclined to protect individuals from hypertension both in genotype and haplotype analyses.

Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study.

BACKGROUND: Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes. However, the association between depression and myocardial injury on cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) has still not been assessed. AIM: To assess the association between depression and myocardial injury on CMR in patients with STEMI. METHODS: A total of 107 STEMI patients undergoing primary percutaneous coronary intervention (P-PCI) were analyzed in this prospectivecohort study. Each subject completed the Patient Health Questionnaire-9 (PHQ-9) to assess the presence and severity of depressive symptoms. CMR was performed at a median of 3 d after P-PCI for quantifying post-MI myocardial injury. Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed. RESULTS: In this study, 19 patients (17.8%) were diagnosed with major depression identified by the PHQ-9 ≥ 10. PHQ-9 was analyzed both as a continuous variable and dichotomous variable. After multivariable adjustment, the proportion of patients with large infarction size was significantly higher in the major depression group (PHQ-9 ≥ 10) (OR: 4.840, 95%CI: 1.122-20.868, P =0.034). When the PHQ-9 was evaluated as a continuous variable, after multivariable adjustment, an increased PHQ-9 score was associated with an increased risk of large infarction size (OR: 1.226, 95%CI: 1.073-1.401, P =0.003). CONCLUSION: In patients with STEMI undergoing PCI, depression was independently associated with a large infarction size.

[The roles and regulation mechanism of transcription factor GATA6 in cardiovascular diseases].

The GATA transcription factor family consists of six members, GATA1 through GATA6, which play important roles in the regulation of cell growth and differentiation, cell survival, and maintenance of body functions. Current studies regarding GATA6 transcription factor confirm that GATA6 plays a crucial role in the differentiation, development, and function of the human heart. Genetic mutations of GATA6 are associated with a variety of congenital heart diseases, dysfunction of the cardiac conduction system causing various arrhythmias, coronary artery disease, and dilated and hypertrophic cardiomyopathies. The relationship between GATA6 and the human heart is also impacted by multiple other genes and interactions in the body. In this review, we summarize the research and current knowledge of the GATA6 transcription factor related to the human heart and multiple pathologies which provides understanding of its genetic basis to enable future personalized gene therapy and to promote the development and incorporation of basic research into clinical medicine.

Association of rs2271037 and rs3749585 polymorphisms in CORIN with susceptibility to hypertension in a Chinese Han population: A case-control study.

Corins are membrane-bound protease that regulates blood pressure by activating the natriuretic peptides. These pro-atrial natriuretic peptide convertases are essential for sodium homeostasis and normal blood pressure. CORIN variants have been identified in humans and other animals, but no studies of CORIN polymorphisms have been conducted in northeastern China. This study aims to investigate the association of 2 single nucleotide polymorphisms (SNPs) in CORIN (rs2271037 and rs3749585) with hypertension, as well as their potential interactions with some risk factors of hypertension in a Han population of northeastern China. A case-control study, including 402 patients with hypertension and 406 participants with normal blood pressure, was conducted in Liaoning province. SNP genotyping was carried out by high resolution melting (HRM) after polymerase chain reaction amplifications. Since rs3749585 is located in 3' untranslated region (UTR) of CORIN, in silico analysis was used to predict target micro RNAs on TargetScan, miRanda, and DIANA-microT. As a result, mutant T allele in rs2271037 (odds ratio [OR], 1.693; 95% confidence [CI], 1.528-1.877; p < 0.001) and C allele in rs3749585 (OR, 1.114; 95% CI 1.011-1.227; p = 0.029) increased the risk of hypertension, comparing with wild G allele and T allele, respectively. Patients with genotype TT (OR, 10.209; 95% CI, 6.414-16.250; p < 0.001) and GT (OR, 1.730; 95% CI, 1.226-2.443; p = 0.002) have higher risk of hypertension than those with genotype GG. SNP rs2271037 was significantly associated with susceptibility to hypertension in all genetic models (dominant model: OR, 2.879; 95% CI, 2.080-3.986; p < 0.001; recessive model: OR, 7.159; 95% CI, 4.779-10.724; p < 0.001; additive model: OR, 1.535; 95% CI, 1.163-2.027; p = 0.002). SNP rs3749585 was significantly correlated with hypertension susceptibility only in dominant model (OR, 1.533; 95% CI, 1.073-2.189; p = 0.019), but not in recessive model (OR, 1.220; 95% CI, 0.906-1.644; p = 0.191) or additive model (OR, 0.915; 95% CI, 0.694-1.205; p = 0.527). After adjusting for age, gender, body mass index (BMI), smoking, low-density lipoprotein cholesterol, and serum sodium level in logistic models, the same statistical results were obtained. Interaction study showed the association between CORIN polymorphisms and hypertension could be changed by overweight (BMI ≥ 25 kg/m2). In silico analyses implicated hsa-miR-495 as a target miRNA that potentially interacts with the 3' UTR of CORIN. In conclusion, polymorphisms of rs2271037 and rs3749585 in CORIN were significantly associated with hypertension in a Han population of northeastern China. The mutant-type T allele of rs2271037 and C allele of rs3749585 might increase the susceptibility to hypertension in this population.

Association between GRK4 and DRD1 gene polymorphisms and hypertension: a meta-analysis.

The role of GRK4 and DRD1 genes in hypertension remains controversial. We performed a meta-analysis to determine whether GRK4 and DRD1 polymorphisms influence the risk of hypertension and examined the relationship between the genetic variances and the etiology of hypertension. Relevant case-control studies were retrieved by database searches and selected according to established inclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the strength of the associations. Meta-regression, subgroup analysis, and sensitivity analysis were performed. A total of 15 articles containing 29 studies were finally included. In the dominant model, rs4532 locus of DRD1 gene was related to hypertension with a pooled OR of 1.353 (95% CI =1.016-1.802, P=0.038). Subgroup analysis for ethnicity showed that rs1024323 locus of GRK4 gene was associated with hypertension in Caucasians (OR =1.826, 95% CI =1.215-2.745, P=0.004) but not in East Asians and Africans. Rs4532 locus was associated with hypertension in East Asians (OR =1.833, 95% CI =1.415-2.376, P,0.001) but not in Caucasians. These data provide possible references for future case-control studies in hypertension.

Association of tag SNPs of GPx-3 with essential hypertension in rural Han Chinese in Fuxin, Liaoning, China.

BACKGROUND: Genetic mechanisms contribute to blood pressure regulation. This study investigated whether glutathione peroxidase (GPx-3) tag single nucleotide polymorphisms (SNPs) are associated with hypertension in the rural areas of Fuxin county, Liaoning province, China. METHODS: Indigenous Fuxin Han people participated, 523 unrelated hypertensives and 547 controls were recruited. All tag SNPs of GPx-3 gene were selected. We estimated SNP allele frequency in DNA pools with pyrosequencing. RESULTS: Before Bonferroni correction, C allele frequency for rs8177417 was significantly higher in hypertensives than those in controls (23.4% vs. 19.3%, P = 0.014); T allele frequency for rs3828599 was significantly lower in hypertensives than those in controls (35.6% vs. 40.8%, P = 0.009). However, when a Bonferroni correction for multiple testing was applied, only the polymorphisms rs3828599 of GPx-3 gene was associated with hypertension (P = 0.045, OR: 0.833, 95%CI: 0.695 - 0.998). CONCLUSION: The polymorphism of rs3828599 of GPx-3 gene might be associated with hypertension in rural Han Chinese from Fuxin, Liaoning.

[Analysis of therapeutic effects of rural patients with hypertension by combination administration of low dosage of hydrochlorothiazide and nitrendipine].

OBJECTIVE: To evaluate the therapeutic effects of combination administration of hydrochlorothiazide and nitrendipine at low dosage in the treatment of rural hypertension patients. METHODS: By the method of cluster random sampling, 5292 primary hypertension patients from Fuxin, Liaoning Province were divided into health education group (control group) and drug intervention group in June 2006. The drug intervention group were treated with hydrochlorothiazide, nitrendipine and captopril by stepwise approach and we observe the antihypertensive effect of drug and the effect on the onset of stroke. RESULTS: The average follow-up time was 15 months. At last, 308 patients were lost to follow-up (the lost follow-up rate was 5.8 percent). The 4984 in cohort, including 2530 of intervention group and 2454 of control group, had examination of all indicators. Through health education and drug intervention, the average blood pressure in drug intervention group decreased by 16.1/9.4 mm Hg (1 mm Hg = 0.133 kPa) while the average blood pressure in control group decreased by 6.7/3.5 mm Hg. The control rate of blood pressure in drug intervention group was higher than control group (33.1% vs. 15.1%, P < 0.001). Through drug intervention, the morbidity risk of nonfatal stroke in drug intervention group decreased by 57.3% compared to control group, the total morbidity risk of stroke decreased by 59.4%. The results had significant statistical difference. And, the morbidity of severe hypopotassaemia (K(+) < 3.0 mmol/L) and diabetes mellitus had no significant statistical difference between two groups. CONCLUSIONS: The low-cost antihypertensive program based on thiazide had good antihypertensive effect, high safety and good cost-effect ratio. The program could be used in rural areas of China.

[Correlation between body mass index, waist circumference and blood pressure in rural residents from west part of Liaoning Province].

OBJECTIVE: This study observed the association between body mass index (BMI), waist circumference (WC) and blood pressure level in rural residents from west Liaoning province. METHODS: This epidemiological study using stratified cluster random sampling was conducted from 2004 to 2006 in Fuxin County, Liaoning Province, 43,692 rural residents (21,680 males) aged 35-74 years old [(49. 8 +/-10.2) years] were surveyed. Database was established with the help of Epidata 3.1 software. RESULTS: In total 43,692 persons were surveyed, including 21,680 male (49.6%) and 22,012 female (50.4%). The average BMI and WC was (23.31 +/- 3.08) kg/m2 and (80.87 +/- 9.0) cm, respectively. No matter male or female, SBP started from 20 kg/m2, increased with the increase of BMI; DBP increased gradually with the increase of BMI; the prevalence of hypertension were significant differences among different BMI groups (P < 0.001). Multiple logistic regression show that in male, using the group with BMI, <18 kg/m2 as control, 28-30 kg/m2 group OR and 95% CI was 6.285 (4.612-8.566); in female, when BMI >22 kg/ m2 OR increased with the increasing of BMI. In male and female, both SBP and DBP, also the prevalence rate of hypertension increased gradually with the increase of WC (P < 0.001). No matter in male or female, when BMI <24 kg/m2, and WC male <85 cm, female WC <80 cm, the average blood pressure levels and prevalence of hypertension are the lowest; after adjusting for age and other risk factors, the prevalence rate of overweight and obesity for male with hypertension OR are 1.704 (1.592-1.825) and 3.710 (3.148 -4.371) , respectively, for female is 1.527 (1.428-1.632) and 3.014 (2.668-3.405), respectively. When the WC is higher than the standard, male and female hypertension risk OR and 95% CI are 1.231 (1.153-1.314) and 1.353 (1.269-1.442), respectively. CONCLUSION: Both BMI and WC are risk factors of hypertension.

Prevalence, awareness, treatment & control of hypertension in rural Liaoning province, China.

BACKGROUND & OBJECTIVE: Hypertension is a major risk factor for cardiovascular and renal diseases. In PR China, the prevalence of hypertension has substantially increased during the past four decades. Information on prevalence as well as awareness regarding treatment and prevention of hypertension is scarce particularly in rural settings. The objective of this study was therefore to estimate the prevalence and distribution of hypertension and to determine the status of hypertension awareness, treatment, and control in the general rural adult population in northeast China. METHODS: During 2005--2007, in Liaoning province of northeast China a probability proportional to size sampling method was used to select a nationally representative sample. A total of 45,925 adults (aged > 35 yr) were examined. Three blood pressure measurements were obtained by trained observers using a standardized sphygmomanometer after a 5-minute sitting rest. Information on history of hypertension and use of antihypertensive medications was obtained. Hypertension was defined as a mean systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, and/or use of antihypertensive medications. RESULTS: Overall, 37.8 per cent of the rural adult population from northeast China aged 35 to 85 yr had hypertension. Among hypertensives, only 29.5 per cent were aware of their high blood pressure, 20.2 per cent were taking antihypertension medication and 0.9 per cent achieved blood pressure control (< 140/90 mm Hg). Of all subjects, 43.9 per cent did not think that high blood pressure would endanger their lives. The reasons why not taking antihypertensive medication in hypertensives aware of having hypertension was 40.2 per cent for their lack of knowledge about the fatalness of hypertension and 32.3 per cent for financial straits. INTERPRETATION & CONCLUSION: Our results indicated that hypertension is highly prevalent in rural areas of northeast China. The percentages of those with hypertension who were aware, treated and controlled were unacceptably low. These results underscore the urgent need to take comprehensive controlling measures and improve the awareness of hypertension at the same time to control hypertension in rural population of Liaoning province.

[Relationship between pulse pressure, pulse pressure index and prevalence of stroke among rural population in China].

OBJECTIVE: To investigate the association between pulse pressure (PP), pulse pressure index (PPI), and stroke in rural areas. METHODS: 29970 people>or=35 years old in rural areas of Fuxin City, Liaoning Province, were selected by cluster multistage sampling. Blood pressure was measured. History of stroke was taken. SPSS11.5 statistical software was used for data analysis. RESULTS: (1) The prevalence of stroke was 2.48%. (2) The PP level of the stroke group was 65 mm Hg+/-19 mm Hg in men and 70 mm Hg+/-21 mm Hg in women; while the PP level of the non-stroke group was 52 mm Hg+/-14 mm Hg in men and 53 mm Hg+/-17 mm Hg in women. The PPI level of the stroke group was 0.40+/-0.08 in men and 0.42+/-0.08 in women; while the PPI of the non-stroke was 0.38+/-0.07 in men and 0.39+/-0.07 in women. The PP and PPI levels of the stroke group were significantly higher than those of the non-stroke group (both P<0.01). (2) The prevalence of stroke increased along with the increase of PP and PPI in both genders (both P<0.01). (3) Receiver operating characteristic (ROC) curve analysis showed that the areas of PP and PPI under ROC curve was 0.720 (95% CI, 0.694-0.746) and 0.581 (95% CI, 0.553-0.610) in men when the optional cutoff was selected; and were 0.755 (95% CI, 0.727-0.784) and 0.681 (95% CI, 0.583-0.650) in women. The sensitivity in prediction of stroke of PP was higher than that of PPI; and the specificity in prediction of stroke of PP was lightly lower than that of PPI in men and was higher than that of PP in women. The area of PP under ROC curve was significantly larger than that of PPI (P<0.01). CONCLUSIONS: As risk factors of stroke, PP and PPI are associated with the prevalence of stroke. PP is superior to PPI in predicting the prevalence of stroke.

[Exploration on the relationship between thrombosis and stability of coronary atherosclerotic plaque in patients with unstable angina pectoris].

OBJECTIVE: To evaluate the correlation between thrombosis and stability of atherosclerotic plaque within criminal vessels in patients with unstable angina pectoris (UAP) by coronary angioscopy, to explore the clinical pathological basis for acute coronary syndromes (ACS). METHODS: Sixty-eight patients with UAP were enrolled, the patients with post-infarction angina pectoris and variant angina pectoris were excluded. There were 48 males and 20 females, aged from 40 to 73 (average 62.4 +/- 8.6) years. The criminal vessels of there patients were observed by coronary angioscopy during percutaneous coronary intervention (PCI) therapy. RESULTS: There were 68 criminal vessels in 68 patients. Atherosclerotic plaques were observed in all criminal vessels. Among criminal vessels, thrombi and intimae lesions were detected in 63 cases and 46 cases, respectively. Among 68 cases with atherosclerotic plaques, there were 48 cases of yellow plaques (70.5%), 18 cases of light yellow plaques (26.5%) and 2 cases of white plaques (2.94%). Sixty-three thrombi cases were mural and on-occlusive, which included 11 cases of red or mixed thrombi (17.5%) and 52 cases of white or pink thrombi (82.5%). All intimae lesions were accompanied by thrombosis, which included 11 cases of red or mixed thrombi (23.9%) and 35 cases of white or pink thrombi (76.1%). CONCLUSION: The study has shown that the rupture of unstable yellow plaque and its thrombosis were the pathological basis of UAP. Therefore, stabilizing yellow plaque before its rupture may play critical role in prevention and treatment of ACS.