Prognosis Of Coronary Heart Disease Research Articles

Does Anxiety Affect Survival in Patients with Coronary Heart Disease?

Behavioral and physiological risk factors worsen the prognosis of coronary heart disease (CHD). Anxiety is known to be a psychological predictor of CHD. In this study, we investigated whether this factor is associated with all-cause mortality in CHD patients in the long term. We studied 180 patients (mean age 60.6 SD 9.2 years, 26% women) with CHD from the Berlin Anxiety Trial (BAT) and the Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) study. Their cardiac and psychological risk profile was represented by standardized procedures, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Mortality outcomes were assessed using a community-based registry. Of 180 patients, we obtained information on all-cause mortality in 175 (96.7%) after a mean follow-up of 12.2 years (range 10.4-16.6 years). Of all participants, 54.4% had prior myocardial infarction, 95.3% had percutaneous transluminal coronary angioplasty and 22.2% had prior coronary artery bypass graft. Most of the patients (98.4%) had New York Heart Association class I and II, 25.6% had diabetes and 38.2% were smokers. Patients had a mean HADS anxiety score of 9.7 SD 4.1 at study entrance. We found the highest HADS anxiety quartile all-cause mortality in 14%, 30.2% in the middle quartiles and 58.7% in the lowest quartile (chi2 20.8, p = 0.001). Related to psychological mechanisms, a low level of anxiety, seemed to be a significant predictor of all-cause mortality. We found no advantage for patients who had received psychosocial therapy in terms of survival. These first data confirmed our hypothesis about the association of psychological risk factors with the long-term outcome of CAD patients. Future studies will clarify whether the severity of disease, age or a particular type of coping or denial mechanism are associated with the presented outcome in low-anxious patients.

Prognostic Value of Pentraxin-3 Change After Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction.

So far, ST-segment elevation myocardial infarction (STEMI) is still the main cause of morbidity and mortality of cardiovascular diseases worldwide. Recent studies showed that pentraxin-3 (PTX3) was related to the early diagnosis and prognosis of coronary heart disease. This study aimed to investigate the dynamical change of PTX3 after primary percutaneous coronary intervention (pPCI) in STEMI patients and its prognostic value. In this prospective cohort study, a total of 350 patients were enrolled. The plasma level of PTX3 was measured at admission, 24-hour and 5-day after pPCI. The primary endpoint was the incidence of major adverse cardiac cerebral events (MACCEs) during 1-year follow-up. Compared with the admission, PTX3 levels were significantly increased at 24 hours, and decreased at 5 days after pPCI in the whole cohort. PTX3 levels at these three time points were not significantly different between the patients with and without MACCEs. Notably, the change in PTX3 from admission to post-pPCI 24-hour (ΔPTX3) was higher in patients with MACCEs (112.83 vs 17.94 ng/dl, P = 0.001). The ROC curves showed that the cut-off value was 29.22 ng/dl and the area under curves was 0.622 (95% CI: 0.554-0.690, p = 0.001). Multivariable cox regression models revealed that the high ΔPTX3 group was an independent predictor of MACCEs (adjusted HR = 2.010, 95% CI = 1.280-3.186, p = 0.003). The higher ΔPTX3 group had significantly higher incidences of revascularization (HR = 2.094, 95% CI: 1.056-4.150, p = 0.034) and composite MACCEs (HR = 2.219, 95% CI: 1.425-3.454, p < 0.001). However, the change of PTX3 level from admission to post-pPCI 5-day had no independently predictive value. The higher increase of PTX3 level 24-hour after pPCI appeared to have a potential value in independently predicting the incidence of 1-year MACCEs in STEMI patients, especially for coronary revascularization.

SOCIO-DEMOGRAPHIC INDICATORS IN PATIENTS WITH CORONARY HEART DISEASE ACCOMPANIED BY DEPRESSION

Depressive disorders are more common both in the general population (more than 350 million people suffer from depressive disorders) and among patients with cardiovascular disease, especially coronary heart disease. The World Health Organization predicts that, by 2030, coronary heart disease and depressive disorders will play a leading role in disability and incapacity for work in the developed countries of the world. The prevalence of depressive disorders at the population level ranges from 2.5% to 10% [1, 2]. Depression is a risk factor for coronary heart disease, negatively influences the course of cardiovascular diseases, and adverse prognosis of the disease in such categories of people is a significant predictor [3, 4]. So, the Whitehall II study showed that the sharper the symptoms of depression, the higher the risk of coronary heart disease [5]. In addition, in patients suffering from cardiovascular diseases, the depressive state aggravates the clinical picture of the disease, and a direct link between the severity of depression and the risk of death has been established [6-11]. Because depression is not diagnosed and treated in time, patients often seek outpatient care and are hospitalized [11]. Due to complications of angina pectoris and many non-coronary complaints, patients' quality of life decreases. Thus, in patients with coronary heart disease in the postoperative period, against the background of depression, an additional decrease in their functional capabilities is revealed [12]. The negative influence of depressive disorders on the development of coronary heart disease is caused by behavioral and physiological mechanisms. The dysfunction of the hypothalamic-pituitary-adrenal, thyroid, and immune systems of the body and the disruption of serotonin, melatonin, and dopamine receptor activity are observed against the background of depression. One of the most important mechanisms of depression's effect on coronary heart disease prognosis is that sympathoadrenal system activation increases the risk of life-threatening cardiac rhythm disturbances [3, 5, 8, 13–15]. Depression significantly changes the behavior of patients with cardiovascular diseases and reduces their quality of life: patients do not want to follow their diet and treatment regimen, do not want to quit smoking or consuming alcohol, do not want to increase physical activity, and do not want to switch to a healthy lifestyle [16–19]. Often, depressive disorders are accompanied by anxiety. Anxiety increases the risk of coronary heart disease by about 41% and the risk of other cardiovascular diseases by up to 52% [20, 21], while increasing the risk of fatal cardiovascular cases [22] and reducing patients' social activity [23]. ]

Clinical and Genetic Aspects of Depression Comorbid Coronary Heart Disease

Objective: to analyze available scientific publications on the problem of clinical and genetic aspects of depressive disorders in patients with coronary heart disease (CHD). Material and methods: by keywords “coronary heart disease”, “mental disorders”, “depression”, “genetics”, “genetic markers”, “polymorphism”, “personality” articles in English and Russian were searched in the MEDLINE/PubMed, Scopus, Web of science, eLibrary databases in the period from 2020 to 2021. Conclusion: depression comorbid CHD is considered as a clinical problem due to its high prevalence, as well as its influence on the features of the course and prognosis of CHD, as well as on the compliance of patients. Heterogeneity of the clinical structure of depressive disorders in CHD (nosogenic, endogenomorphic, endogenous, somatogenic depression) causes difficulties in differential diagnosis and complex therapeutic measures. There are several factors contributing to the onset of depression in CHD patients: biological, clinical, personal characteristics. Genetic markers of depression in CHD, which have prognostic value, require further clarification.

Serum Itih4 in Coronary Heart Disease: A Potential Anti-Inflammatory Biomarker Related to Stenosis Degree and Risk of Major Adverse Cardiovascular Events

Aim: This study aimed to investigate the correlation of ITIH4 with inflammatory cytokines, stenosis degrees and prognosis in coronary heart disease (CHD) patients. Methods: Serum ITIH4 levels of 300 CHD patients and 30 controls, together with levels of TNF-α, IL-6, IL-8 and IL-17A of CHD patients, were determined using ELISA. Results: Serum ITIH4 was reduced in CHD patientsversus controls (p<0.001). ITIH4 was negatively linked with TNF-α, IL-6, IL-8, IL-17A, C-reactive protein, serum creatinine and Gensini score in CHD patients (all p<0.050). ITIH4 quartile level negatively correlated with the cumulative major adverse cardiovascular event rate (p=0.041). Conclusion: Serum ITIH4 may serve as an anti-inflammatory biomarker that negatively associates with stenosis degree and major adverse cardiovascular event risk in CHD patients.

Impact of depression on the quality of sleep and immune functions in patients with coronary artery disease

BackgroundThe risk of major depressive disorder (MDD) and insomnia is higher in patients with coronary heart disease (CHD) than in the general population. In addition, immune inflammation may be a...

Is elevated triglyceride/high-density lipoprotein cholesterol ratio associated with poor prognosis of coronary heart disease? A meta-analysis of prospective studies.

Elevated triglycerides (TG) and reduced high-density lipoprotein cholesterol (HDL-C) are recognized as essential and independent hazard factors for total death and major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD). However, whether the increased TG/HDL-C forecasted the prognosis of CHD is still unknown. Therefore, we performed a meta-analysis to investigate the relationship between the elevated TG/HDL-C ratio and poor prognosis of CHD. A systematic literature search was conducted in PubMed, Web of Science, EMBASE, and The Cochrane Library, until August 30, 2021. Prospective observational studies regarding the association between TG/HDL-C and long-term mortality/MACEs in CHD patients were included. In total, 6 independent prospective studies of 10,222 participants with CHD were enrolled in the systematic and meta-analysis. Our outcomes of the meta-analysis indicated that the elevated TG/HDL-C group had a significantly increased risk of long-term all-cause mortality (hazard ratio [HR] = 2.92, 95% confidence interval [CI]: 1.75-4.86, P < .05) and long-term MACEs (HR = 1.56, 95%CI 1.11-2.18, P < .05). In patients with CHD, the present study showed that the high TG/HDL-C was associated with increased risk of long-term all-cause mortality and MACE.

Triglyceride-glucose index in the prediction of major adverse cardiovascular events in patients with type 2 diabetes mellitus after coronary artery bypass surgery: A retrospective cohort study.

Insulin resistance (IR) is a significant risk factor for cardiometabolic diseases and a defining feature of type 2 diabetes mellitus (T2DM). This study aimed to examine the potential value of triglyceride-glucose (TyG) index as a predictor of prognosis in coronary heart disease (CHD) patients with T2DM after coronary artery bypass grafting (CABG) surgery and to facilitate the identification of those at high risk of major adverse cardiovascular events (MACEs) for closer monitoring or possible early intervention. This study enrolled 386 T2DM patients who underwent CABG surgery at Nanjing Drum Tower Hospital. Patients were separated into two groups according to the median preoperative TyG Index. The Kaplan-Meier plot was used to compare the rate of MACEs-free survival in T2DM patients after CABG. The independent risk factors for the occurrence of MACEs were investigated using multivariate analysis. Nomogram was used to depict the predictive model. Significantly more MACEs occurred in individuals with higher medians of the TyG index (65 (33.7%) vs. 39 (20.2%), p=0.003). TyG index [hazard ratio (HR) 12.926], LVEF [hazard ratio (HR) 0.916], and NYHA functional class III/IV [hazard ratio (HR) 4.331] were identified as independent predictors of MACEs incidence in post-CABG T2DM patients by multivariate analysis. The area under the curve (AUC) for predicting MACEs using the TyG index was 0.89 at five years. Combining the TyG index, LVEF, and NYHA functional class III/IV to build a novel risk assessment model for postoperative MACEs, the AUC climbed to 0.93 at five years. With AUCs, the nomogram comprised of the TyG index, LVEF, and NYHA functional class III/IV demonstrated strong specificity in the training and test sets. The incidence of MACEs is high among post-CABG T2DM patients with a high TyG index. TyG index improves the diagnostic accuracy of MACEs, especially at long-term follow-up. A high TyG index may serve as an early warning signal for individuals to undertake lifestyle adjustments that can reduce the progression or incidence of MACEs.

DeTransUnet: attenuation correction of gated cardiac images without structural information

Objective. Myocardial perfusion imaging (MPI) with positron emission tomography (PET) is a non-invasive imaging method, and it is of great significance to the diagnosis and prognosis of coronary heart disease. Attenuation correction (AC) for PET images is a necessary step for further quantitative analysis. In order not to use magnetic resonance (MR) or computed tomography (CT) images for AC, this work proposes DeTransUnet to obtain AC PET images directly from no-attenuation corrected (NAC) PET images. Approach. The proposed DeTransUnet is a 3D structure which combines the multi-scale deformable transformer layers and the 3D convolutional neural network (CNN). And it integrates the advantages of transformer with long-range dependence and CNN suitable for image calculation. The AC images using CT images for AC and scatter correction (SC) and are considered as training labels, while the NAC images are reconstructed without AC and SC. Standard uptake value (SUV) values are calculated for both NAC and AC images to exclude the influence of weight and injection dose. With NAC SUV images as the inputs of the DeTransUnet, the outputs of DeTransUnet are AC SUV images. Main results. The proposed DeTransUnet was performed on an MPI gated-PET dataset, and the results were compared with Unet2D and Unet2.5D. The metrics of the whole image and the left ventricular myocardium show that the proposed method has advantages over other deep learning methods. Significance. The proposed DeTransUnet is a novel AC framework that does not require CT or MR images. It can be used as an independent AC method on PET/MR instrument. In addition, when CT images contain defects or cannot be registered with PET images on PET/CT instrument, DeTransUnet is able to repair the defects and keep consistent with the NAC images.

The association between DNA methylation of 6p21.33 and AHRR in blood and coronary heart disease in Chinese population

BackgroundEarly detection could significantly improve the prognosis of coronary heart disease (CHD). In-invitro diagnostic technique may provide a solution when sufficient biomarkers could be identified. Pertinent associations between blood-based aberrant DNA methylation and smoking, the pathogenesis of atherosclerosis, and CHD have been robustly demonstrated and replicated, but that studies in Chinese populations are rare. The blood-based methylation of aryl-hydrocarbon receptor repressor (AHRR) cg05575921 and 6p21.33 cg06126421 has been associated with cardiovascular mortality in Caucasians. Here, we aim to investigate whether the AHRR and 6p21.33 methylation in the blood is associated with CHD in the Chinese population.MethodsIn this case–control study, 180 CHD patients recruited at their first registration in our study center, and 184 controls randomly selected from the people who participated in the annual health examination were enrolled. Methylation intensities of 19 CpG sites, including AHRR cg05575921, 6p21.33 cg06126421, and their flanking CpG sites, were quantified by mass spectrometry. The association between methylation intensities and CHD was estimated by logistic regression analyses adjusted for covariant.ResultsCompared to the controls, lower methylation of 6p21.33_CpG_4.5/cg06126421 was independently associated with increased odds of being a CHD patient (OR per − 10% methylation = 1.42 after adjustment for age, gender, and batch effect; p = 0.032 by multiple testing corrections). No association between blood-based AHRR methylation and CHD was found.Conclusions6p21.33 methylation exhibits a significant association with CHD. The combination of 6p21.33 methylation and conventional risk factors might be an intermediate step towards the early detection of CHD.

Plasma Exosomal S1PR5 and CARNS1 as Potential Non-invasive Screening Biomarkers of Coronary Heart Disease.

BackgroundEarly diagnosis and treatment significantly improve the prognosis of coronary heart disease (CHD), but no convenient screening tools are available. This study aims to find potential non-invasive screening biomarkers of coronary heart disease.MethodWe performed microarray analysis to investigate the mRNA expression levels in Small extracellular vesicles (sEVs) and screen significantly differentially expressed mRNAs in CHD patients vs. non-CHD patients. We then performed quantitative real-time polymerase chain reaction (qRT-PCR) to validate the microarray results, and we calculated the correlations between expression levels and clinicopathological data. Microarray analysis identified 72 downregulated mRNAs and 31 upregulated mRNAs in CHD patients relative to non-CHD patients.ResultsFrom the study, we found that upregulated sphingosine-1-phosphate receptor 5 (S1PR5) and downregulated carnosine synthase 1 (CARNS1) had the most significant differences between the patient group and the control group. S1PR5 expression was correlated with diabetes, heart rate, triglycerides, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and fasting blood glucose (P < 0.05). CARNS1 level was correlated with uric acid (UA) (P < 0.05). Overexpressed S1PR5 and downregulated CARNS1 were independent risk factors for CHD. The area under the receiver operating characteristic curve (AUC) of S1PR5 was 0.838 for diagnosing CHD; the AUC of CARNS1 was 0.883 for non-CHD; and the AUC of S1PR5 plus CARNS1 was 0.921 for CHD.ConclusionsMicroarray analysis showed that upregulated S1PR5 and downregulated CARNS1 in sEVs have the potential to become non-invasive biomarkers for CHD screening.

Clinical Utility of Amplification Refractory Mutation System-Based PCR and Mutation-Specific PCR for Precise and Rapid Genotyping of Angiotensin-Converting Enzyme 1 (ACE1-rs4646996 D>I) and Angiotensin-Converting Enzyme 2 (ACE2-rs4240157T>C) Gene Variations in Coronary Artery Disease and Their Strong Association with Its Disease Susceptibility and Progression

Background: Experimental clinical and research studies demonstrated that the renin–angiotensin system (RAS) affects the pathogenesis of atherosclerosis and the prognosis of coronary heart disease (CHD). The results show that ACE2 (angiotensin I-converting enzyme 2) might act as a protective protein for cardiovascular diseases; however, only a few studies in human populations have been carried out. The aim of this study was to develop, optimize, and validate a direct T-ARMS-based PCR assay for the precise and rapid genotyping of ACE1-rs4646996 D>I and ACE2-rs4240157T>C and study their association with coronary artery disease susceptibility and progression. Methodology: This study included 149 consecutive coronary artery disease patients and 150 healthy controls. We utilized T-ARMS for the precise and rapid genotyping of ACE2-rs4240157; rs4646994. Results: Our results indicated that the ACE1-rs4646996 D>I genotypes observed between CAD cases and controls were statistically significant (p < 0.008) and, similarly, the ACE2-rs4240157T>C genotypes observed were significant (p < 0.0001). Moreover, the frequency of the D allele (ACE1-D>I) and C allele (ACE2-rs4240157T>C) was found to be higher among CAD patients than the HC. Our results indicated that in the codominant model, the ACE2-ID genotype was strongly associated with increased CAD susceptibility in a codominant model with an OR of 2.37, (95%) CI = (1.023–5.504), and p < 0.04. Similarly, the ACE2-DD genotype was strongly associated with an increased CAD susceptibility with an OR of 3.48, (95%) CI = (1.49 to 8.117), and p < 0.003. Similarly, in allelic comparison, the D allele was strongly associated with CAD susceptibility with an OR of 1.59, (95%) CI = (1.12–2.24), and p < 0.003. Our results revealed that there was a significant correlation between ACE2-I/D genotypes and hypertension, T2D, and obesity (p < 0.05). The results of ACE2 rs4240157 genotyping indicated a strong association in the codominant model with an increased CAD susceptibility with an OR of 3.62, (95%) CI = (2.027 to 6.481), and p < 0.0001. Similarly, in a dominant inheritance model, a strong association is observed between the ACE2 rs4240157 (CT+CC) genotype with an OR of 6.34, (95%) CI = (3.741 to 10.749), and p < 0.0001. In allelic comparison, the T allele was strongly associated with CAD susceptibility with an OR of 5.56, (95% CI = (3.56 to 7.17), and p < 0.0001. Similarly, our results revealed that there was a significant association of the ACE2-rs4240157T>C genotypes with Triglycerides (mg/dL), HDL-C (mg/dL), total Cholesterol (mg/dL), and C-reactive protein (mg/L) in CAD. Conclusion: It was indicated that the ARMS technique and MS-PCR assay proved to be fast, accurate, and reliable for ACE2-rs4240157T>C and ACE1-rs4646996 D>I, respectively, and can be used as a potential molecular tool in the diagnosis of genetic diseases in undeveloped and developing countries—where there might be a shortage of medical resources and supplies. ACE1-I>D genotypes were strongly associated with T2D, hypertension, and obesity (p < 0.002). Besides the ACE2-rs4240157 CT heterozygosity genotype, the T allele was strongly associated with CAD susceptibility. Future longitudinal studies in different ethnic populations with larger sample sizes are recommended to validate these findings

The Effect of Blood Pressure Variability on Coronary Atherosclerosis Plaques.

Hypertension is one of the most important risk factors for coronary heart disease (CHD). The regulation of blood pressure plays a significant role in the development and prognosis of CHD. Blood pressure variability (BPV) refers to the degree of fluctuation of blood pressure over a period of time and is an important indicator of blood pressure stability. Blood pressure fluctuations are complex physiological phenomena, being affected by physiological and pharmacological effects and regulated by behavioral, environmental, hydrodynamic, and neural factors. According to the different time periods for measuring BPV, it can be divided into very short-term, short-term, mid-term, and long-term. Multiple cardiovascular disease animal models and clinical experiments have consistently indicated that abnormal BPV is closely related to coronary events and is a risk factor for CHD independently of average blood pressure. Thrombosis secondary to plaque rupture (PR) or plaque erosion can cause varying blood flow impairment, which is the main pathological basis of CHD. Plaque morphology and composition can influence the clinical outcome, treatment, and prognosis of patients with CHD. Research has shown that PR is more easily induced by hypertension. After adjusting for the traditional factors associated with plaque development, in recent years, some new discoveries have been made on the influence of abnormal BPV on the morphology and composition of coronary plaques and related mechanisms, including inflammation and hemodynamics. This article reviews the impact of BPV on coronary plaques and their related mechanisms, with a view to prevent the occurrence and development of CHD by controlling BPV and to provide new prevention and treatment strategies for the clinical treatment of abnormal blood pressure.

The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures.

Objective To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. Methods A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. Results Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01). Conclusion Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.

Impacts of Omaha System-Based Continuing Care on the Medication Compliance, Quality of Life, and Prognosis of Coronary Heart Disease Patients After PCI.

IntroductionThe objective of this study is to explore the impacts of Omaha System-based continuing care on medication compliance, quality of life (QOL), and prognosis of coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI).MethodsA total of 100 CHD patients who were hospitalized and received PCI were selected and divided into the control group and the observation group, 50 patients per group, according to a random number table method. The control group was given routine care, while the observation group was applied Omaha System-based continuing care on the basis of the control group.ResultsFollow-up demonstrated that the Morisky-Green score of the observation group was significantly higher than that of the control group (P<0.001), indicating that the medication compliance of the observation group was significantly better than that of the control group (P<0.001). The short form-36 (SF-36) scores were notably higher after nursing compared with on admission; SF-36 scores of the observation group were significantly increased than those of the control group (P<0.001). The incidence of major adverse cardiac event (MACE) in the observation group was significantly lower than in the control group (P<0.001). The nursing satisfaction of the observation group was considerably higher than that of the control group (P<0.01).ConclusionOmaha System-based continuing care could improve the medication compliance and QOL, reduce the incidence of MACE, and benefit the prognosis of CHD patients after PCI.

The Potential of Prognostic Biomarkers of Uric Acid Levels in Coronary Heart Disease Among Aged Population: A Scoping Systematic Review of the Latest Cohort Evidence.

BackgroundThis study sought to determine whether uric acid levels have a relationship with and can potentially be used as a prognosis for coronary heart disease (CHD) biomarkers using a scoping review.MethodsThis study was conducted following Arksey and O’Malley’s scoping review framework. It was reported as obeying the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review (PRISMA-ScR). The subject was extensively searched for in PubMed, CINAHL, and ScienceDirect. The inclusion criteria in the study were that the sources were journal articles written in English and were available in full text. The age of the subject in the item is the elderly population to capture the relationship between uric acid levels and the prognosis of CHD. The publication time limit was 2010 to 2020. The study was analyzed using thematic analysis.ResultsWe identified 592 studies in our initial search, and 21 studies with a cohort design were included in this study’s analysis. The majority of the evidence suggests an independent correlation with a poor prognosis of CHD in the elderly population. The prognosis of gout includes the prognosis of clinical outcome, severity, and mortality, all of which influence the prognosis value, which becomes a marker.ConclusionUric acid levels have been identified as a potential biomarker for poor CHD prognosis. Nurses and other healthcare workers should learn how to control poor CHD prognosis.

PROSPECTS OF MELDONIUM AND FOLIC ACID USING TO IMPROVE THE CONDITION OF PATIENTS WITH ISCHEMIC HEART DISEASE AND CONCOMITANT HYPERTENSION

Coronary heart disease (CHD) is a leading cause of high mortality, disability and reduced quality of life for patients. At the heart of coronary heart disease - ischemia and activation of oxidative stress. With concomitant hypertension, the condition of patients and the prognosis for the course of their disease deteriorates significantly. The prognosis of coronary heart disease, the occurrence of new hospitalizations or deaths from cardiovascular disease can be further assessed by monitoring ST2 and malonic dialdehyde (MDA). Traditional treatment of coronary heart disease does not always guarantee the achievement of the desired clinical results. That is why it is advisable to use in the complex treatment of patients with coronary heart disease and concomitant hypertension cytoprotectors and drugs that have antioxidant properties, such as meldonium and folic acid.&#x0D; The aim of the research. Detect anti-ischemic activity in meldonium and folic acid and evaluate the effect of these drugs on the level of ST2, MDA in the blood in patients with coronary heart disease and concomitant hypertension.&#x0D; Materials and methods. The research included 80 patients (women - 4, men - 76, aged 57,7 ± 9,8 years) with diagnoses of coronary heart disease: stable angina, functional class II-III (FC), chronic heart failure (CHF) I-IIa, FC II-III ", with concomitant arterial hypertension II-III stages, 2-3 degrees, risk 4 (very high), CHF I-IIa, FC II-III". Patients were divided into 4 groups of 20 patients, respectively: 1) patients who, in addition to basic therapy, were prescribed folic acid at a dose of 0.8 mg / d for six months; 2) patients who, in addition to basic treatment, were prescribed meldonium at a dose of 750.0 mg / d for six months; 3) patients who, in addition to basic treatment, were prescribed folic acid at a dose of 0.8 mg / d and meldonium at a dose of 750.0 mg / d for six months; 4) patients who were prescribed only basic antianginal, disaggregating, hypolipidemic treatment.The number of anginal attacks and doses of nitroglycerin during the day were determined, the results of the test with a 6-minute walk and the plasma concentration of ST2 and MDA before and after 6 months of treatment with meldonium and folic acid were evaluated.&#x0D; Results. Found anti-ischemic activity in meldonium and its combination with folic acid. The combination of these drugs as an adjunct to basic therapy significantly reduced the concentration of ST2. Both drugs alone or in combination reduced the concentration of MDA in the blood of patients.&#x0D; Conclusions. Our research showed the presence of anti-ischemic activity in meldonium, both when added to the basic therapy of patients with coronary heart disease and concomitant hypertension, and when used together with folic acid. In the groups of patients where these drugs and their combinations were used, the frequency of anginal attacks and the number of doses of nitroglycerin used during the day were significantly reduced.&#x0D; The combined use of folic acid and meldonium when added to the basic therapy after 6 months significantly reduced the concentration of ST2 in the blood. Folic acid and meldonium showed pronounced antioxidant properties. At separate adding of these medications to basic therapy or their combined adding significantly decreased the concentration of MDA - a marker of oxidative stress.&#x0D; Therefore, we consider it appropriate to use folic acid and meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension.

Identification of Key Exosome Gene Signature in Mediating Coronary Heart Disease by Weighted Gene Correlation Network Analysis.

Background Coronary heart disease (CHD) is the most prevalent disease with an unelucidated pathogenetic mechanism and is mediated by complex molecular interactions of exosomes. Here, we aimed to identify differentially expressed exosome genes for the disease development and prognosis of CHD. Method Six CHD samples and 32 normal samples were downloaded from the exoRbase database to identify the candidate genes in the CHD. The differentially expressed genes (DEGs) were identified. And then, weighted gene correlation network analysis (WGCNA) was used to investigate the modules in coexpressed genes between CHD samples and normal samples. DEGs and the module of the WGCNA were intersected to obtain the most relevant exosome genes. After that, the function enrichment analyses and protein-protein interaction network (PPI) were performed for the particular module using STRING and Cytoscape software. Finally, the CIBERSORT algorithm was used to analyze the immune infiltration of exosome genes between CHD samples and normal samples. Result We obtain a total of 715 overlapping exosome genes located at the intersection of the DEGs and key modules. The Gene Ontology enrichment of DEGs in the blue module included inflammatory response, neutrophil degranulation, and activation of CHD. In addition, protein-protein networks were constructed, and hub genes were identified, such as LYZ, CAMP, HP, ORM1, and LTF. The immune infiltration profiles varied significantly between normal controls and CHD. Finally, we found that mast cells activated and eosinophils had a positive correlation. B cell memory had a significant negative correlation with B cell naive. Besides, neutrophils and mast cells were significantly increased in CHD patients. Conclusion The underlying mechanism may be related to neutrophil degranulation and the immune response. The hub genes and the difference in immune infiltration identified in the present study may provide new insights into the diagnostic and provide candidate targets for CHD.

Current patterns of pharmacological treatment for coronary heart disease based on the Russian cohort of the hospital arm of the EUROASPIRE V survey

Abstract Background Several drug classes have shown their ability to improve risk factors control and prognosis in coronary heart disease (CHD). Therefore, it is important to monitor the prescription patterns on a regular basis to ensure that all the eligible patients receive the potentially lifesaving medications. Purpose To describe prescription and uptake of main guideline-recommended drug classes in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population. Methods The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and &amp;lt;80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and &amp;lt;2 years after the index hospitalization. Pharmacological treatment was assessed based on the prescriptions in the discharge letters and during the interview. Results A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The table below represents the proportion of pts prescribed and actually receiving main drug classes. Both in the Russian cohort and in the whole study population the proportion of patients receiving essential drug classes didn't differ much by gender. In Russian centers, 95.9% of men and 91.7% of women received antiplatelets (vs 92.8% and 91.8%, respectively, in the whole study population). For statins the corresponding numbers were 86.9% for men and 91.7% for women in Russia (vs 82.2% and 76.8%), for beta-blockers – 82.5 in both genders (vs 80.8% and 81.8%), for ACE inhibitors and/or ARBs 78.0% in men and 80.6% in women (vs 75,3% and 75.0%). Conclusion Current prescription of guideline-recommended drug classes in the Russian cohort of EUROASPIRE V survey is close to the average European levels and doesn't demonstrate any obvious gender gaps. However, there is still room for improvement. In particular, this applies to the maintenance of prescriptions made at discharge, especially of statins, in the long term. Funding Acknowledgement Type of funding sources: None. Table 1

Association of Derived Neutrophil-To-Lymphocyte Ratio With Prognosis of Coronary Heart Disease After PCI.

Aims: The present study aimed to investigate the prognostic role of derived neutrophil-to-lymphocyte ratio (dNLR) in patients with coronary heart disease (CHD) after PCI.Methods: A total of 3,561 post-PCI patients with CHD were retrospectively enrolled in the CORFCHD-ZZ study from January 2013 to December 2017. The patients (3,462) were divided into three groups according to dNLR tertiles: the first tertile (dNLR < 1.36; n = 1,139), second tertile (1.36 ≥ dNLR < 1.96; n = 1,166), and third tertile(dNLR ≥ 1.96; n = 1,157). The mean follow-up time was 37.59 ± 22.24 months. The primary endpoint was defined as mortality (including all-cause death and cardiac death), and the secondary endpoint was major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs).Results: There were 2,644 patients with acute coronary syndrome (ACS) and 838 patients with chronic coronary syndrome (CCS) in the present study. In the total population, the all-cause mortality (ACM) and cardiac mortality (CM) incidence was significantly higher in the third tertile than in the first tertile [hazard risk (HR) = 1.8 (95% CI: 1.2–2.8), p = 0.006 and HR = 2.1 (95% CI: 1.23–3.8), p = 0.009, respectively]. Multivariate Cox regression analyses suggested that compared with the patients in the first tertile than those in the third tertile, the risk of ACM was increased 1.763 times (HR = 1.763, 95% CI: 1.133–2.743, p = 0.012), and the risk of CM was increased 1.763 times (HR = 1.961, 95% CI: 1.083–3.550, p = 0.026) in the higher dNLR group during the long-term follow-up. In both ACS patients and CCS patients, there were significant differences among the three groups in the incidence of ACM in univariate analysis. We also found that the incidence of CM was significantly different among the three groups in CCS patients in both univariate analysis (HR = 3.541, 95% CI: 1.154–10.863, p = 0.027) and multivariate analysis (HR = 3.136, 95% CI: 1.015–9.690, p = 0.047).Conclusion: The present study suggested that dNLR is an independent and novel predictor of mortality in CHD patients who underwent PCI.