Coronary Atherosclerotic Heart Research Articles

Role of Plasma Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 and microRNA-98 in Severity and Risk of Coronary Artery Disease.

Coronary artery diseases are the most important cause of premature death, and these diseases are predominantly related to atherosclerosis. Soluble lectin-like oxidized low-density lipoprotein receptor-1 and microRNAs are closely associated with atherosclerotic coronary heart diseases. To investigate the relationship between the severity and risk of coronary artery disease and plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 and miR-98. Case-control study. Angiographically documented patients with 38 single-vessel, 75 double-vessel, and 62 multi-vessel coronary artery disease; 62 healthy control participants; and 24-hour hypoxic (1% oxygen) human umbilical vein endothelial cells were included in this study. Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations were determined through enzyme-linked immunosorbent assays, and miR-98 expressions were measured by quantitative real-time polymerase chain reaction. The expressions of plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels were progressively and significantly higher in patients with single-vessel, double-vessel, and multi-vessel coronary artery disease than in healthy controls (p<0.001). Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 concentrations in female patients with multi-vessel, double-vessel, and single-vessel coronary artery disease had evidently elevated compared with that in male patients (p<0.001). Plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels were remarkably increased in females with coronary artery disease in different age groups compared with the males in the same age groups (p<0.001). Patients with single-vessel (areas under the curve=0.879), double-vessel (area under the curve=0.928), and multi-vessel (area under the curve=0.943) coronary artery disease have been clearly differentiated from healthy participants with respect to high sensitivity and specificity. The expression of miR-98 was noticeably downregulated in patients with single-, double- and multi-vessel occluded coronary artery disease and in hypoxic human umbilical vein endothelial cell compared with controls (p<0.001). Significantly elevated lectin-like oxidized low-density lipoprotein receptor-1 and caspase-3 activity and remarkably decreased cellular viability in hypoxic injured human umbilical vein endothelial cell. On the contrary, mimic of miR-98 markedly reduced caspase-3 and lectin-like oxidized low-density lipoprotein receptor-1 levels and highly increased cellular viability. Elevated circulating plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels have a potential impact to identify the severity of coronary artery disease and have a strong correlation with aging as well as the female gender. Reduced plasma miR-98 level is possibly considered a risk factor for coronary artery disease, and agomiR-98 prevents atherosclerosis and cellular injury by targeting lectin-like oxidized low-density lipoprotein receptor-1.

Risk Factors and Cardiovascular Disease (CVD) Related Outcomes in Hospitalized Patients with Hemophilia 10 Year Follow up

Introduction: Comprehensive management for patients with hemophilia has drastically improved outcomes, quality of care, and longevity. Because of increases in life span, patients with hemophilia may be at risk for other chronic conditions including cardiovascular disease (CVD). Though initially it was thought that hemophilia might have been protective for cardiovascular disease further research has shown that CVD remains a significant risk for the aging hemophilia population. This study aims to determine the prevalence of risk factors and outcomes for CVD in hospitalized adult and pediatric patients with the discharge diagnosis of Hemophilia A or B compared to patients without Hemophilia. We examine longitudinal changes over the previous decade. WMethods: The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was utilized for analysis of years 2007 and 2017. The NIS uses a stratified probability sample of 20% of all inpatient discharges (representing more than 97% of the US population). Hemophilia-A and B were identified using ICD-9 code 286.0 and 286.1, ICD-10 codes D66 and D67 respectively and sampling weights were applied to generate nationally representative estimates. Cardiovascular risk factors and outcomes were determined by evaluating ICD-9 codes for 2007 data and ICD-10 codes for 2017 data. For comparative historical data, 2007 NIS data from a prior published study [Goel et al., Hemophilia (2012), 18, 688-692] were used. The NIS is a de-identified, publicly available data set. This study was deemed exempt from review from the Johns Hopkins Institutional Review Board. This analysis was conducted in accordance with the HCUP data use agreement guidelines. Results: In 2017, there were 10,555 admissions with Hemophilia A or B listed as one of all diagnoses. The mean age of hemophilia patients was 44.31 years compared to 49.57. years for all admissions. The most prevalent risk factor in 2017 was hypertension (32.4% for admissions with hemophilia as compared to 35.3% for all admissions) followed by hyperlipidemia (19.4% compared to 27.5%), diabetes (17.4% compared to 22.8%) and obesity (10.8% compared to 14.4%). CVD outcomes, in descending order of frequency were atherosclerotic coronary artery disease (11.6% for admissions with hemophilia compared to 16.9% for all admissions), heart failure (10.2% compared to 14.2%), acute myocardial infarction (AMI) (2.2% compared to 3.9%), and stroke (2.2% compared to 2.4% respectively). Comparing to 10 year prior data, in 2007, there were 9,737 admissions with Hemophilia A or B listed as one of all diagnoses. The mean age of hemophilia patients was 30.89 years compared to 47.16 years for all admissions. The most prevalent risk factor in 2007 was hypertension (27.0% in admissions with hemophilia compared to 36.7% for all admissions); followed by diabetes (11.2% compared to 18.5%), hyperlipidemia (9.5% compared to 17%), and obesity (3.6% compared to 5.8%). CVD outcomes, in descending order of frequency were, atherosclerotic coronary artery disease (10.1% compared to 16.7%), heart failure (6.6% compared to 10.8%), AMI (2.1% compared to 2.4%), and stroke (2.0% compared to 1.7%). Between 2007 and 2017 the crude prevalence rates of all CVD risk factors as well as CVD outcomes generally increased for admissions with hemophilia as well as all-cause hospitalizations. Conclusions: The frequency of all CVD risk factors (obesity, diabetes, hypertension, and hyperlipidemia) as well as CVD outcomes (atherosclerosis, congestive heart failure, AMI, and stroke) increased between 2007 and 2017 in hospitalized patients both with and without hemophilia. While the unadjusted prevalence rates for all CVD risk factors and CVD outcomes were less in hospitalized patients with hemophilia compared to the general hospitalized population in both 2007 and 2017, CVD remains a significant risk for the hemophilia population. An improved understanding of the various risk factors will help to improve CVD outcomes in the aging hemophilia population. Disclosures Takemoto: Genentech: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: DSMB Aplastic Anemia Trial.

Role of Plasma Soluble Lectin Like Oxidized Low-Density Lipoprotein Receptor-1 in Severity of CAD Patients and Relationship with Microrna-98

Coronary artery diseases are the most important cause of premature death and it is predominantly related to atherosclerosis. Soluble lectin like oxidized low-density lipoprotein receptor-1 (sLOX-1) and microRNAs are closely associated with atherosclerotic coronary heart diseases. The current study investigated the relationship of plasma slOX-1and the severity of coronary artery disease patients (CAD) and association with microRNA-98. Case control study. Angiographically documented 38 single coronary lesions, 75 double coronary artery disease, 62 multi-vessel coronary artery disease patients, 62 healthy control subjects, and 24h hypoxic (1% O2) HUVEC cells were included in this study. Circulating sLOX-1concentrations were determined through enzyme-linked immunosorbent assays and microRNA-98 expressions were measured by the quantitative real- time polymerase chain reaction. The expressions of plasma sLOX-1 levels were progressively and significantly higher in single, double, and multi-vessel CAD patients than healthy control subjects (p<0.001). Circulating sLOX-1 concentrations in multi-vessel, double vessel and single vessel CAD female subjects had evidently elevated than male subjects (p<0.001). Plasma sLOX-1 values were remarkably increased in female different age groups CAD patients as compared with the same male age subjects (p<0.001). Single vessel diseased (AUC 0.879), double vessel diseased (AUC 0.928) and multi-vessel diseased (AUC 0.943) CAD patients have been clearly differentiated from healthy participants with high sensitivity and specificity. The expression of microRNA-98 noticeably down-regulated in single, double and multi-vessel occluded CAD patients and hypoxic exposed HUVEC than controls (p<0.001). Significantly elevated LOX-1 and caspase-3 activity and remarkably decreased cellular viability in hypoxic injured HUVEC. On the contrary, mimic of microRNA-98 markedly reduced caspase-3 and LOX-1 levels and highly increased cellular viability. Elevated circulating plasma sLOX-1 levels have a potential impact to identify the severity of coronary artery disease and a strong correlation with aging as well as the female gender. Reduced plasma miR-98 level possible considers a risk factor for CAD, and agomiR-98 prevents atherosclerosis and cellular injury through targeting LOX-1.

Abstract 235: A Joint Cardiometabolic Program: An Innovative Approach to Providing Care for High-Risk Patients With Cardiovascular Disease

Introduction: There are over 400 million adults with diabetes mellitus (DM) worldwide. Diabetes is associated with multiple vascular complications; atherosclerotic cardiovascular disease (ASCVD) and coronary heart disease (CHD) are major mediators of morbidity and mortality in diabetic patients. In fact, the association between these disease states is so strong that DM is considered a CHD equivalent. New consensus guidelines in both the cardiology and endocrinology literature now support the use of DM medications that enhance cardiovascular health and significantly reduce major adverse cardiovascular events (MACE). Hypothesis: Collaboration among disciplines, particularly endocrinology, cardiology, social work, diabetes education and pharmacy will improve care of patients with co-morbid diabetes and cardiovascular disease. This will be demonstrated by improved adherence to guideline recommended risk modifying treatments. Methods &amp; Conclusions: A collaborative cardiometabolic clinic has been established at a large tertiary care center. The focus of this venture is on the optimization of guideline directed medical therapies through joint office visits with both cardiology and endocrinology. Patients admitted with Type II DM, MI (STEMI or NSTEMI), or CHD requiring CABG, are identified by inpatient providers and referred to our clinic. Prior to the appointment, the patient’s insurance formulary is screened, so that appropriate medications are prescribed at the time of the visit. Patients are then returned to their primary outpatient providers with recommendations for long term management. Observational data from this clinic will be compared to retrospective outcomes analysis of a similar demographic of patients prior to the establishment of this collaborative clinic. As our therapeutic landscape broadens comprehensive cardiometabolic care will continue to be of paramount importance for patients with co-morbid cardiovascular disease and diabetes.

Predictive value of phase analysis of gated myocardial perfusion imaging for major adverse cardiac events in patients with coronary artery disease

Objective To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease. Methods Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE (χ2 values: 4.126, 6.021, both P 80°), abnormal entropy(>58 J·mol-1·K-1) and SSS≥12 were independent risk factors for MACE (odds ratio(OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P 26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification. Key words: Coronary artery disease; Prognosis; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tomography, X-ray computed; Technetium Tc 99m sestamibi

The mediating role of empowerment level in self-management and quality of life in patients with chronic coronary heart disease

Objective To explore the mediating role of empowerment level in self-management and quality of life in patients with coronary heart disease, and to provide evidence for interventions to improve quality of life in patients with coronary heart disease. Methods 215 patients with coronary atherosclerotic heart disease in cardiovascular department of hospital in Dalian were selected as the subjects. The Chronic Empowerment Scale, Self-management Behavior Scale of Coronary Heart Disease, China Cardiovascular Patient Quality of Life Assessment Questionnaire and self-made general information questionnaire were used for investigation. Results The total empowerment, self-management and quality of life of patients with coronary heart disease were (158.75±20.39), (74.50±11.55), and (73.31±23.01). The empowerment, self-management and quality of life of patients with coronary heart disease were positively correlated (r=0.512-0.642, P<0.01). Self-management has a direct positive predictive effect on quality of life. The level of empowerment has a partial mediating effect between self-management and quality of life, and the contribution rate of mediating effect was 31.5%. Conclusions Empowerment, self-management and quality of life of patients with coronary heart disease are closely related. Self-management can influence the quality of life through the empowerment. Nurses should develop active and effective empowerment programs to improve patients' self-management ability and their quality of life. Key words: Empowerment; Self-management; Quality of life; Coronary artery disease

Analysis of occurrence regularity and risk factors of deep venous thrombosis in patients with distal fractures of the knee during perioperative period

Objective To investigate the occurrence of deep venous thrombosis (DVT) in the perioperative period of patients with fracture distal to the knee, so that clinicians have a better understanding of the occurrence of DVT in the perioperative period of the fracture distal to the knee. Methods A retrospective analysis of the clinical data of 365 patients with distal knee fractures who underwent surgery in the Department of Orthopaedics Trauma, Xi′an Jiaotong University Medical College Red Cross Hospital from June 2014 to March 2018 was conducted. There were 213 males and 152 females, aged (45.05±15.24) years, with an age range of 17-83 years. Classification of fracture sites: 177 cases of tibiofibular shaft fracture, 130 cases of ankle fracture, and 58 cases of foot fracture. According to whether thrombosis occurred or not, the patients were divided into thrombotic group and non-thrombotic group before and after operation. There were 66 patients with thrombosis before operation, 299 patients without thrombosis before operation, 88 patients with thrombosis after operation, and 277 patients without thrombosis after operation. The incidence of thrombosis and the location of the thrombus were recorded. The sex, age, fracture site, ASA score, operation time, the time from injury to admission, the time from injury to surgery, intraoperative tourniquet time, intraoperative blood transfusion volume, intraoperative blood loss, intraoperative transfusion volume, hemoglobin volume at admission and 1 day after operation, D-dimer level at admission and 1 day after operation, multiple injuries, chronic hepatitis and medical diseases were analyzed. The measurement data of normal distribution and homogeneity of variance were expressed as mean±standard deviation (Mean±SD), the t test was used for comparison between two groups. The comparison of count data was performed by χ2 test or Fisher exact probability method, and multivariate logistic regression analysis was performed on the risk factors affecting the occurrence of DVT in both lower extremities. Results The preoperative DVT rate was 18.1% (66/365). In patients with thrombosis, distal thrombosis accounted for 93.94% (62/66), and mixed thrombosis accounted for 6.06% (4/66). The incidence of postoperative DVT was 24.1% (88/365). In patients with thrombosis, distal thrombosis accounted for 94.32% (83/88), proximal thrombosis accounted for 1.14% (1/88), and mixed thrombus accounted for 4.55% (4/88). Fracture site, ASA score, operation time, intraoperative tourniquet time, intraoperative blood transfusion volume, intraoperative blood loss, intraoperative transfusion volume were not statistically significant(P>0.05). Age ≥ 40 years (OR=2.691, 95% CI: 1.422-5.093, P=0.002), the time from injury to admission>3 days (OR=1.927, 95%CI: 1.072-3.463, P=0.028) were independent risk factors for DVT formation in fracture distal to the knee before operation. Age ≥ 40 years (OR=3.925, 95% CI: 2.161-7.129, P=0.000), the time from injury to surgery >5 days (OR=1.835, 95%CI: 1.080-3.119, P=0.025), D-dimer level at 1 day after operation (OR=1.191, 95%CI: 1.096-1.293, P=0.000), combined with multiple injuries (OR=1.981, 95%CI: 1.006-3.902, P=0.048), combined with coronary atherosclerotic heart disease (OR =2.692, 95%CI: 1.112-6.517, P=0.028) were independent risk factor for DVT formation after operation for fracture distal to the knee. Conclusions The occurrence of DVT before and after the fracture of the knee is mainly caused by distal thrombosis, and proximal thrombosis also occurs. Those patients aged≥40 years, combined with multiple injuries and coronary heart disease, should focus on preventing the occurrence of DVT. After the injury, the patient is immediately admitted to the hospital for DVT screening, and when the general condition allowed, shortening the preoperative waiting time can reduce the occurrence of DVT. Key words: Fracture; Venous thrombosis; Risk factors

Relationship between TREM-1 gene polymorphism and susceptibility to coronary atherosclerotic heart disease

Objective To explore the relationship between gene polymorphisms of triggering receptor expressed on myeloid cells-1 (TREM-1) rs2234237A/T, rs9471535A/G and susceptibility to coronary atherosclerotic heart disease(coronary heart disease for short, CHD). Methods A case-control study. 120 patients with CHD (CHD group) and 90 healthy people (Normal control group) were selected from November 2016 to April 2017 in Jingzhou Central Hospital. The single nucleotide polymorphisms(SNPs) of TREM-1gene (rs2234237 and rs9471535)were analyzed using Sanger method in all subjects. Comparing baseline clinical data and the distribution of genotype frequencies in the two groups. Non conditional logistic regression was used to analyze the relationship between TREM-1 gene ( rs2234237 and rs9471535) polymorphisms and susceptibility to CHD. Results The proportion of gender as well as level of age, body mass index, total cholesterol, triglyceride and low density lipoprotein cholesterol were not statistically significant between the two groups(χ2 =0.575, P>0.05; t=-1.670, P>0.05; t=-1.719, P>0.05; t=1.011, P>0.05; t=-1.834, P>0.05; t=0.474, P>0.05, respectively), while the proportion of smoking, hypertension and diabetes as well as level of high density lipoprotein cholesterol and fasting plasma glucose were statistically significant between the two groups (χ2 =4.321, P 0.05). Conclusions TREM-1 gene rs2234237 A/T and rs9471535 A/G polymorphisms are significantly associated with susceptibility to CHD . rs2234237 TT genotype and rs9471535 GG genotype might act as protective factors of CHD.(Chin J Lab Med, 2018, 41: 436-441) Key words: Coronary disease; Triggering receptor expressed on myeloid cells-1; Polymorphism, single nucleotide; Disease susceptibility

Promoting effects of dual heart care mode on patients' health behaviors in perioperative period of coronary artery bypass surgery

Objective To evaluate the effects of dual heart care mode in perioperative period of coronary artery bypass grafting (CABG) surgery on improving health behavior in patients with coronary atherosclerotic heart disease. Methods A total of 131 patients with atherosclerotic heart disease who were treated in the Cardiac Surgery Department of Yancheng Third People's Hospital of Jiangsu Province from January 2011 to December 2016 were recruited by convenience sampling method. All the patients were divided into observation group (2014.1-2016.12, n=68) and control group (2011.1-2013.12, n=63) according to the admission date. The observation group was treated with dual heart path nursing mode, while the control group was treated with routine perioperative care. The scores of self-rating anxiety scale (SAS) , health promoting lifestyle profile (HPLP) and the incidence of adverse cardiovascular events were compared between the two groups. Results There was no significant difference in the incidence of anxiety, the scores of SAS and HPLP between the two group on admission (P>0.05) . Before surgery and 7 days after surgery, the incidence of anxiety and the score of SAS of the observation group were all lower than those of the control group, and the difference was statistically significant (P<0.05) . The score of HPLP of the observation group was higher than that of the control group before discharge, and the difference was statistically significant (P<0.05) . After surgery, there were 6 cases of adverse cardiovascular events in the observation group, and 17 cases in the control group. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group, with statistical significant difference (P<0.05) . Conclusions Dual heart path nursing mode guides nurses to give standardized perioperative holistic nursing and psychological nursing according to predetermined care plan, so that the perioperative nursing work is more standardized, more secure and more humanized. In conclusion, it improves the quality of nursing overall. Key words: Coronary artery bypass, off-pump; Perioperative nursing; Health behavior; Dual heart path care

The predictive value of AGEs in the risk and prognosis of coronary heart disease in diabetic patients

Objective To predict the value of advanced glycation end products (AGEs) in the risk and severity of coronary heart disease in diabetic patients. Methods Totally 120 cases were divided into 3 groups. Group A had no diabetes mellitus (DM) and no coronary atherosclerotic heart disease (CAD). Group B had DM without CAD. Group C had DM with CAD. The levels of AGEs, low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin, and the severity of coronary stenosis were detected. Receiver operating characteristic (ROC) curve was used to evaluate the sensitivities and specificities of AGEs for the diagnosis of DM with CAD. Results The highest level of AGEs , LDL-C, glycosylated hemoglobin and carotid plaque was in the C group, with a statistically significant difference (P<0.05). The severity of AGEs was significantly correlated with the severity of CAD and the Gensini score of AGEs (r=0.445). ROC curve showed that the sensitivity, specificity and area under ROC curve of AGEs determination of DM with CAD were 80.0%, 75.0%, and 0.86, respectivity. Conclusions The level of AGEs is significantly correlated with atherosclerosis and prognosis in DM. The severity of CAD was higher in the patients with higher AGEs, and the incidence and severity of restenosis increased. Key words: Diabetes mellitus, type 2/CO/ME; Coronary disease/CO/ME; Prognosis

Preliminary evaluation of the relationship between the level of plasma of miR-125b-5p and the lesion degree of coronary arteryin in coronary atherosclerotic heart disease

Objective To investigate the clinical value of circulating miR-125b-5p in coronary atherosclerotic heart disease. Methods With case-control study, 80 cases of coronary atherosclerotic heart disease were recruited in Affiliated Hospital of Nantong University from February 2014 to august 2015. According to coronary angiography result they were divided into two groups: there are coronary artery stenosis group(n=49) and control group(n=31). All patients were also divided into non-ST -segment elevation myocardial infarction and ST-segment elevation myocardial infarction group (n=35), unstable angina group group (n=25), stable angina group (n=20). The level of miR-125b-5p before coronary angiograph was detected. By independent sample t test and variance analysis, the levels of miR-125b-5p were compared between the groups of coronary artery stenosis and the group with no stenosis of the coronary artery, the coronary artery lesions in each group, and between the various types of coronary atherosclerotic heart disease respectively. Results MiR-125b-5p expression level of Coronary artery stenosis group (0.35±0.10)was lower than that in group coronary artery with no stenosis(0.95±0.12), the difference was statistically significant (t=24.179, P<0.000 1). With the increase in the number of diseased coronary arteries, miR-125b-5p expression level decreased gradually. There is also statistical significance (t=8.399, P<0.000 1; t=13.067, P<0.000 1) in miR-125b-5p expression among NSTEMI+ STEMI, UA and SAP groups. miR-125b-5p expression level was negatively correlated with Gensini score (R2=0.822, P<0.05). The area under the ROC curve(AUC) of miR-125b-5p was 0.86(95% CI 0.67-0.90), and 0.66 was the optimal cut-off value with sensitivity of 81.22% and specificity of 78.62%. Conclusions With the increase of the number of stenosis, plasma miR-125b-5p expression level decreased gradually. The expression level of miR-125b-5p was negatively correlated with the Gensini score of coronary artery, which indicated that the expression level of miR-125b-5p may be a potential biomarker that can reflect the lesion degree of coronary artery.(Chin J Lab Med, 2017, 40: 396-399) Key words: Coronary disease; microRNAs; Coronary vessels; Severity of illness index; Biological markers

Clinical analysis of perioperative application and complications of Intra-aortic Balloon Pump in cardiac surgery

Objective To assess the perioperative efficacy and complications of intra-aortic balloon pump(IABP) in patients with cardiac operation. Methods A total of 36 cases with IABP patients from January 2011 to September 2016 were studied in Luhe Hospital of Beijing Affiliated to Capital Medical University, inluding 27 patients with coronary atherosclerotic heart disease(CAD), 8 patients with valvular heart diseaseand and 1 patient with left atrial myxoma.The clinical data was collected to analyze IABP efficacy and complications. Results There were 10(27.8%) patients died, the mortality rate of CAD patients was lower than that of non-CAD patients(18.5% vs.55.6%, X2=4.615, P=0.032). The related complications after IABP implantation included: 6(16.7%) cases suffered from thrombocytopenia, 3(8.3%) cases with lower limb ischemia, 2(5.6%) cases with lower extremity arterial thromboembolism, 2(5.6%) cases with femoral artery pseudoaneurysm, 2(5.6%) cases with acute pancreatitis, 1(2.8%) cases with intestinal necrosis by mesenteric ischemia, 2(5.6%) cases with gastrointestinal bleeding, 3(8.3%) cases with hemorrhage in puncture site, 4(11.1%) cases of fever, 1(2.8%) case with pipeline leak, and 1(2.8%) case no pressure lumen data.After treatment with IABP, in 26 cases survival patients, the hemodynamic indexes(mean arterial pressure, heart rate, central venous pressure, urine volume) were significantly improved and the amount of dopamine and epinephrine decreased(t=-22.35, 64.41, 53.31, -23.82, 26.07, 14.15 respectively, P<0.05). Conclusion IABP can significantly improve the perioperative efficacy.The active treatment on complications is important to reduce the death induced by IABP. Key words: Intra-aortic balloon pump; Perioperative period of cardiac operation; Complication

The detection and clinical significance of homocysteine in patients with coronary atherosclerotic heart disease

In recent years, high plasma homocysteine (HHcy) as an independent risk factor for coronary atherosclerotic heart disease (CHD) has been widely received clinical attention. Some detection methods and clinical research for patients with CHD are constantly developing. Enzymatic cycling assay, the most commonly used method at present, represents important application value in the aspects of disease occurrence, severity prediction and therapeutic monitoring for CHD.(Chin J Lab Med, 2016, 39: 726-728) Key words: Coronary disease; Homocysteine; Severity of illness index

The clinical value of serum sialic acid and lactadherin in the prognosis evaluation of atherosclerotic heart disease

Objective To discuss the effect and clinical value of serum sialic acid (SA)and lactadherin(MFG-E8)in the coronary atherosclerotic heart disease(CHD). Methods Selected 295 patients who visited to Wuhan University Renmin's Hospital cardiovascular medicine (from January to June, 2014), and then according to the results of coronary angiography divide the subjects into control group(n=78, the result of coronary angiography completely normal)and coronary heart disease group(n=217, the results of coronary angiography showed that one major coronary stenosis was more than 30%). Detected their serum level of lipid, SA, MFG-E8, hs-CRP index. At last, analyze the differences of SA and MFG-E8 between these groups, and the correlation with the severity of coronary stenosis (symbolize with Gensini score), use the binary logistic regression analysis to research the relationship among the serum level of SA, MFG-E8 and the risk of CHD. Results Compared with the control group, the patients with CHD have a higher level of serum SA and a lower level of MFG-E8 (U=4 402.5, 2 736.0 respectively, P<0.001); the AMI group has a higher level of serum SA than the StA and UA groups (U=1 329.0, 957.5 respectively, P<0.001); the AMI group has a lower level of serum MFG-E8 than the StA groups (U=1517.0, P<0.001). The spearman correlation analysis showed that the serum SA has a positively correlation with the level of TG, hs-CRP and Gensini score, and has a negatively correlated with the level of MFG-E8(r=0.214, 0.462, 0.378, -0.322 respectively, P<0.01); the MFG-E8 has a negatively correlated with the level of TG, hs-CRP and Gensini score (r=-0.18, -0.425, -0.564 respectively, P<0.01). Binary logistic regression analysis showed that there was a positive correlation between the serum SA and the risk of CHD (OD= 4.782, 5.319, 4.179 3.832, 3.648 respectively, P<0.001), and the was a negative correlation between the serum MFG-E8 and the risk of CHD (OD= 0.118, 0.112, 0.127, 0.135, 0.134 respectively, P<0.001). Conclusion With the serum SA rised and the MFG-E8 reduced, the risk of coronary heart disease was higher, combined detection these two indexes may be able to diagnose the CHD and assess the degree of stenosis and the risk of CHD.(Chin J Lab Med, 2015, 38: 746-750) Key words: Coronary disease; N-acetylneuraminic acid; Milk proteins; C-reactive protein; Risk factors

The effect of Diltiazem on the major adverse cardiac events after percutaneous coronary intervention

Objective To detect the impact of Diltiazem on the major adverse cardiac events (MACE) in six months after percutaneous coronary intervention (PCI). Methods A total of 192 patients after PCI with coronary atherosclerotic heart disease were enrolled in this study. The patients were randomly divided into Diltiazem therapy group (101 patients) and non-Diltiazem therapy group (91 patients). The high-sensitivity C-reactive protein (hs-CRP) was assessed before and 24 h after PCI, and the incidence of Major adverse cardiovascular events(MACEs) were assessed at the sixth month after PCI. Results Compared with before PCI, hs-CRP level increased significantly in both group after PCI (P<0.01), but hs-CRP level was lower in Diltiazem therapy group than in non-Diltiazem therapy group (P<0.05 ). Compared with non-Diltiazem therapy group, there was lower incidence of MACEs during six months follow-up in Diltiazem therapy group. Conclusions Diltiazem can decrease the incidence of MACEs during six months after PCI. Key words: Coronary diseose; Angioplasty, transluminal, percutaneous coronary; Calcium channel blockers; C-reactive protein

Intravascular ultrasound study of coronary artery remodeling and plaque composition in patients with coronary atherosclerotic heart disease

Objective To demonstrate the relationship between plaque composition and coronary artery remodeling in the same patient′s blood vessel. Methods A total of 48 coronary artery plaque were included in this study. Qualitative assessment and quantitative measurements of the lesion were performed in target lesions. The lesions were classified into soft plaque, fibrous plaque, calcified plaque and mixed plaque according to different degree of reflection of ultrasound signal. The remodeling index (RI) was defined as the ratio of external elastic membrane cross sectional area of lesion segment to the mean reference external elastic membrane cross sectional area. Results In comparison to hard plaque group, RI of soft plaque group was significantly larger in the same patient (1.08±0.15 vs 1.00±0.13, P=0.000). Soft plaque group presented with more positive remodeling than hard plaque group, but with P value more than 0.05 (83.3% vs 58.3%, P=0.057). The plaque area, lumen area and plaque burden were not different between two group (P>0.05). Conclusions The blood vessel was compensatively dilated in soft plaque segments and RI was significantly larger than in hard plaque segments. Coronary atherosclerotic vessel presented positive remodeling in the acute stage of inflammation. Key words: Endosonography; Coronary artery heart disease; Remodeling; Plaque; Atherosclerotic

Abstract 11882: Comprehensive Hemodynamic Analysis of Coronary Arterial Responses to Acetylcholine Provocation Test in Patients With Coronary Vasospastic Angina

Introduction: Whereas our prior study showed diffuse coronary intimal thickening in pts with coronary vasospastic angina (VSA), coronary epicardial and microvascular (MV) hemodynamic and vessel response during coronary vasospasm has not been well studied. Hypothesis: We hypothesized that coronary pathogenic abnormalities responsible for coronary vasospasm may not be confined to coronary epicardial spastic segments, but the hemodynamic abnormalities may exist in the entire coronary bed. Methods: According to acetylcholine (ACh) provocation tests, excluding pts with atherosclerotic coronary obstruction (stenosis &gt;50% diameter) and possible heart failure (left ventricular ejection fraction &lt;50%), 41 pts were divided into 2 groups; VSA group (n=20) and non-VSA group (n=21). To evaluate hemodynamic parameters comprehensively, average peak velocity (APV), coronary blood flow (CBF: π (APV/2)(vessel diameter/2) 2 ), hyperemic MV resistance (hMR), coronary vascular resistance (CVR: Pd/CBF) and coronary distal pressure (Pd) were measured continuously utilizing a dual-sensor (Doppler velocity and pressure)-equipped guidewire (Combowire, Volcano Therapeutics, Inc.) during ACh provocation test. Results: There were no differences between the 2 groups in baseline characteristics. In spite of absence of between-group differences at baseline in CBF (55±26 vs. 51±29, p=0.5) and CVR (2.4±1.5 vs. 2.6±1.4, p=0.7), intracoronary ACh 100μg provocation significantly increased CVR (2.1±2.2 vs. 0.8±0.7; p=0.001), and then attenuated CBF (77±54 vs. 188±129, p=0.001) in VSA group than in non-VSA group. Furthermore, although coronary flow reserve was identical between the groups (2.2±0.9 [VSA] vs. 2.4±0.9 [non-VSA], p=0.5), hMR was significantly augmented in VSA group (2.0±0.7 vs. 1.6±0.6, p=0.046). Also, there was significantly negative correlation between hMR and estimated glomerular filtration rate, which presumably reflect the integrity of renal MV bed (r=-0.522; p=0.0009). Conclusions: Compared with non-VSA pts, coronary and systemic MV function was impaired in pts with VSA. In vivo assessment using Combowire clarified dynamic entire coronary alteration during ACh provocation test, including coronary MV dysfunction, in pts with VSA.

Experience of anesthesia management for simultaneous coronary artery bypass grafting and lung cancer operation

Two patients,with ASA grade Ⅱ and Ⅲ respectively,scheduled for elective surgeries combining coronary artery bypass grafting (OPCABG) and lung resection,in November 2012 at Shanghai Chest Hospital,were retrospectively analyzed.Both patients received general anesthesia and double-lumen endobronchial tube for lung separation.OPCABG and lung resection were conducted sequentially.Patients were discharged without any perioperaitive complications.Circulation and airway management were key points for anesthesiologists in the management of patients undergoing combination surgical proceduces. Key words: Coronary atherosclerotic heart disease; Coronary artery bypass grafting; Lung tumour; Lung resection; Anesthesia management

The roles of neopterin in patients with coronary atherosclerotic heart disease

Objective The study focused on the relationship between neopterin （NP）, Gensini score and high-sensitivity C-reactive protein (hs-CRP) to explore the important role of the neopterin in patients with coronary heart disease. Methods Total of 442 patients, admitted to the Department of Cardiology at Renmin Hospital, Wuhan University from January 2012 to September 2012, were enrolled in this study. There were 176 patients in the control group and 266 patients with coroary disease in the experimental group. The Gensini score was used to assess the severity of the coronary lesions in the patients with coronary heart disease. The enzyme-linked immunosorbent assays (ELISAs) were used to measure the serum NP level. The other indicators were assessed by use of fully automatic biochemical and coagulation analyzers. The data were analyzed by using of SPSS19.0. T-test was used for analysis of the results between the control group and the experimental group. One-factor analysis variance (ANOVA) was used for comparisons of the results among the 3 groups, and Spearman correlation analysis was used for the correlation analysis between the NP level and Gensini score as well as hs-CRP level. Results The serum NP level was higher in the experimental group than that in the control group ［(1.99±0.37) vs （1.48±0.29） ng/ml，P<0.05］, and the NP level was positively correlated with the severity of coronary heart disease. Compared with the stable angina (SA) group, the serum NP level was significantly increased in the unstable angina (UA) group (2.00±0.37)ng/ml and the acute myocardial infarction (AMI) group (2.10±0.43) ng/ml (t=2.38，P<0.05). In addition, the serum NP level was positively correlated with the Gensini score (r=0.687,P<0.001) as well as with the level of hs-CRP (r=0.190,P<0.001). Conclusions The serum level of NP was significantly higher in patients with coronary heart disease and was positively correlated with the severity of coronary artery disease. Thus, NP may become a new indicator for the assessment of the inflammatory response in coronary atherosclerosis.（Chin J Lab Med,2014,37:513-516） Key words: Coronary disease; Neopterin; Biological markers

The study on the relationship between the change of ST-T of chronic stable CAD and LVEF

Objective To study the relationship between the change of resting electrocardiogram ST-T in chronic stable coronary atherosclerotic heart disease(CAD) and left ventricle enjection fraction(LVEF).To know the significance that the change of ST-T may predict the function of left ventricle.Methods 80 patients with CAD in our c ardaic department were analyzed retrospectively,40 patients with the change of ST-T (positive group) and 40 patients without the change of ST-T(negative group) were analyzed the outcome of LVEF and the extent of coronary lesion.Results The LVEF of positive group was lower than negative group obviously,the comparision between both groups had statistical significance (t =6.125,P =0.000).In the electrocardiogram positive group,the number of the patients who had 2 and more than 2 branches lesion was more than negative group,the comparision between both groups had statistical significance(x2 =9.683,P =0.008).Conclusion The change of ST-T may predict the function of left ventricle of patients with chronic stable coronary atherosclerotic heart disease,the relationship may be connected with the degree of coronary lesion. Key words: Coronary disease; Body surface potential mapping; Stroke volume