Objective To investigate the effect of large dosage of spironolactone on cardiac function and plasma level of brain natriuretic peptide (BNP) in elderly patients with chronic heart failure (CHF).Methods Totally 68 cases with CHF (NYHA cardiac function class Ⅲ and Ⅳ) were randomly divided into study group (with adding spironolactone 20 mg/d and 60 mg/d to conventional treatment,n =34) and control group (conventional treatment,n =34).The cardiac function and plasma level of BNP were evaluated after 6 months treatment.Results The post-treatment plasma level of BNP dropped from ( 921.4 + 284.5) ng/L to ( 316.4 ± 193.3 ) ng/L in study group (t=14.722,P=0.000) and from (904.3 + 274.0) ng/L to (481.3 ± 202.5) ng/L in control group (t=9.271,P=0.000) with significant difference in posttreatment BNP level between two groups (t=4.280,P=0.011).The values of left ventricular ejection fraction (LVEF) were higher after treatment than before treatment in study group[(32.2 + 4.7) ％ vs.(45.1 + 6.2) ％,t =6.820,P=0.004]and in control group[(31.8±5.1) ％ vs.(38.3+5.7)％,t=5.283,P=0.008],and the post-treatment LVEF was much higher in study group than in control group (t=3.844,P=0.017).The value of left ventricular end diastolic diameter (LVEDD) dropped significantly after treatment as compared to before treatment in study group[(58.6±4.4) mm vs.(45.7±4.4) mm,t =5.822,P=0.006]and in control group[(59.1±5.2) mm vs.(52.4±4.8) mm,t=3.018,P=0.024],and there was remarkable difference in LVEDD value between the two groups after treatment (t=3.393,P=0.020).The cardiac function after treatment was markedly improved as compared to before treatment in study group (x2=5.527,P=0.009) and in control group (x2=4.180,P=0.013),and the study group showed a more satisfactory result than control group (x2 =3.273,P=0.022).The incidence of side effects were 11.76％ in the study group and 8.82％ in control group with no significant difference (P=0.116).Conclusions Large dosage of spironolactone added to the conventional therapy may significantly improve cardiac function and decrease plasma BNP,especially for the elderly patients with severe CHF.

Growth differentiation factor(GDF)-15,a distant member of the transforming growth factor-? cytokine superfamily,is a powerful cardioprotective factor.Many studies have demonstrated that serum GDF-15 level is a novel marker closely associated with the diagnosis,risk stratification,and prognosis of several cardiovascular diseases.This article mainly reviews the characteristics of GDF-15 and its multifunction in cardiovascular diseases.

Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequency (RF) energy was delivered to create continuous linear lesions encircling the pulmonary veins. It was delivered with a target temperature of 43℃, a maximal power limit of 30W and applied for ≥20 seconds until the maximal local electrogram amplitude decreased by ≥50%. The ablation was completed by finishing the circular line. Results The mean procedure duration was 180?18 minutes, with mean fluoroscopy time of 80?20 minutes. The average number of RF pulses was 120?15. After a follow-up of 6.0 months, 24 patients maintained sinus rhythm. 3 patients suffered from less frequent paroxysmal atrial fibrillation during the first 3.0 months after the ablation and remained Af free after 6 months. 1 patient had atrial fibrillation episodes and 1 patient had atrial fibrillation attacks unchanged. No pulmonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective.

The association between fasting plasma ghrelin levels and insulin resistance and blood pressure (BP) in octogenarians was investigated in this study. A total of 487 unrelated octogenarians (including 203 men and 284 women) were enrolled in this cross-sectional study at the Healthy Care Center of Shanghai East Hospital, Tongji University, China, from October 2008 to April 2009. Plasma ghrelin was determined by using the enzyme linked immunosorbent assay (ELISA). Insulin sensitivity was assessed using the homeostasis model of assessment-insulin resistance (HOMA-IR). The age of the participants ranged from 80 to 89 years (mean=83.9+/-4.8 years) with a body mass index (BMI) of 25.3+/-4.9 kg/m(2). Plasma ghrelin levels were 20.94+/-5.34 mug/L, being 20.89+/-5.53 mug/L in men and 21.38+/-3.73 mug/L in women respectively. Plasma ghrelin was not associated with systolic (P=0.981) or diastolic (P=0.724) BP, waist circumference (P=0.278), fasting insulin (P=0.246), fasting blood glucose (FBG) (P=0.693) and HOMA-IR (P=0.232). In the control cohort, no significant differences in plasma ghrelin were found between genders (P=0.489), and among subjects with hypertension (BP>140/90 mmHg) (P=0.284) and type 2 diabetes (P=0.776). In conclusion, fasting plasma ghrelin levels are not directly correlated with insulin resistance and BP among octogenarians.

A total of 167 coronary heart disease (CHD) patients were divided into metabolic syndrome (MS) group (68 cases) and non-MS group (99 cases). There were significant differences in the disease-related metabolic indicators and coronary angiography (multivessel lesions, diffuse stenosis, occlusive lesions, Ginsini score) between MS group and non-MS group ( all P<0.05 ). When the patients with MS were divided into 3 groups according to the number of componernts of MS, three lesions, diffuse stenosis, and occlusive lesions were more frequent in five components group compared with three components group. Ginsini points rised with the increased risk factors. There existed differences in Ginsini score between three components group and four, five components group (P<0. 05 or P<0.01 ). Multivariable logistic regression analysis showed that obesity, hypertension,diabetes, high low-density lipoprotein-cholesterol, and low high-density lipoprotein-cholesterol were the predictors of CHD in patients with MS (P<0.05 or P<0.01 ).

AIM: To investigate the effects of angiotensin-converting enzyme inhibitors (ACEI), fosinopril, captopril and angiotensin II AT 1 antagonists, valsartan on tissue factor (TF) expression on monocytes induced by lipopolysaccharide (LPS). METHODS: Mononuclear leukocytes from normal delivered female umbilical veins were incubated with bacterial LPS in presence or absence of different ACE inhibitors .At the end of incubation, the cells were disrupted by 3 freeze-thaw cycles. TF procoagulant activity was assessed by a one-stage clotting assay. RT-PCR was used to check TF mRNA expression, and GAPDH mRNA was used for parallel assay. RESULTS and CONCLUSION: The results showed that increased expression of TF mRNA induced by LPS was inhibited by fosinopril, captopril and valsartan, respectively, and the procoagualant activity of monocytes was also reduced. [

The association between fasting plasma ghrelin levels and insulin resistance and blood pressure(BP)in octogenarians was investigated in this study.A total of 487 unrelated octogenarians (including 203 men and 284 women)were enrolled in this cross-sectional study at the Healthy Care Center of Shanghai East Hospital,Tongji University,China,from October 2008 to April 2009.Plasma ghrelin was determined by using the enzyme linked immunosorbent assay(ELISA).Insulin sensitivity was assessed using the homeostasis model of assessment-insulin resistance(HOMA-IR).The age of the participants ranged from 80 to 89 years(mean=83.9±4.8 years)with a body mass index(BMI)of 25.3±4.9 kg/m2.Plasma ghrelin levels were 20.94±5.34 μg/L,being 20.89±5.53 μg/L in men and 21.38±3.73 μg/L in women respectively.Plasma ghrelin was not associated with systolic(P=-0.981)or diastolic(P=0.724)BP,waist circumference(P=0.278),fasting insulin(P=0.246),fasting blood glucose(FBG)(P=0.693)and HOMA-IR(P=0.232).In the control cohort,no significant differences in plasma ghrelin were found between genders(P=0.489),and among subjects with hypertension (BP＞140/90 mmHg)(P=0.284)and type 2 diabetes(P=0.776).In conclusion,fasting plasma ghrelin levels are not directly correlated with insulin resistance and BP among octogenarians.

Objective:To investigate the incidence rate of aspirin resistance(AR) in elderly patients with coronary heart disease (CHD) accompanied by type 2 diabetes ,and analyze the correlations of AR with gender and age ,so as to provide support of evidence based medicine for the clinical prevention and therapy of geriatric cardiovascular disease .Methods:A total of 186 elder‐ly patients with CHD accompanied by type 2 diabetes were enrolled and treated with low dose aspirin .The incidence rate of AR was detected and evaluated by thrombelastograph platelet mapping assay and platelet activation markers .The correlation of clin‐ical characteristics with gender and age were analyzed .Results:The incidence rate of AR in elderly patients with CHD accom‐panied by type 2 diabetes was 21 .0% (39/186) .The incidence rates of AR in patients ≥ 75 years was higher than that in patients <75 years(P<0 .05) .The incidence rate of AR in female patients were significantly higher than that in male patients (P<0 .05) .The incidence rate of AR in female and male patients ≥75 years was higher than that in female and patients <75 years(P<0 .05) .The incidence rates of major vascular events and micro vascular events in patients with AR were higher than those in patients who were sensitive to aspirin(P<0 .05) .Conclusions:The incidence rate of AR is correlated with gender and age in elderly patients with CHD disease accompanied by type 2 diabetes .

Objective:To investigate the protective mechanism of resveratrol in reducing cardiac ischemia‐reperfusion injury (I/R) of diabetic rats and its effect on autophagy of cardiomyocytes .Methods:Streptozotocin(STZ)‐induced diabetic rat model was constructed and 35 diabetic model rats were randomly divided into five groups ,the sham group ,the resveratrol non‐surgery group ,the I/R group ,the resveratrol treatment group ,and the resveratrol+insulin group ,with 7 rats in each .Then I/R model was built by ligating‐relaxing the left coronary .The change of myocardial infarction size was observed by methylene blue stalning . Autophagic vacuoles were observed with transmission electron microscope (TEM ) . The expression of microtubule‐associated protein 1 light chaln 3(LC3)‐Ⅰ and Ⅱ ,autophagy related gene 5(Atg5) ,Beclin‐1 ,as well as the expression and phosphorylation levels of AMP‐activated protein kinase(AMPK) and mammalian target of rapamycin(mTOR) , were detected by Western blotting .Results:The infarction size in resveratrol treatment group and resveratrol+ insulin group was significantly smaller than that in I/R group(P<0 .05) .TEM showed that in resveratrol treatment group and resveratrol+insulin group ,autophagy of cardiomyocytes could be promoted and the structure of cardiomyocytes could be improved ,when I/R of occurred .The expression levels of LC3‐Ⅱ ,Atg5 ,Beclin‐1 in I/R group were significantly lower than those in sham group (P<0 .05) ,whereas the change of expression levels of LC3‐Ⅰ had no significant difference(P> 0 .05) .Meanwhile ,the expression levels of Atg5 and Beclin‐1 in resveratrol treatment group and resveratrol+ insulin group were significantly higher than those in I/R group ,and the expression level of Beclin‐1 in resveratrol+insulin group was higher than that in resveratrol treatment group(P< 0 .05) .There was no significant difference in the expression level of AMPK and mTOR among the 5 groups(P> 0 .05) .However ,the expression level of p‐AMPK was significantly higher in resveratrol treatment group and resveratrol+insulin group than that in I/R group ,and the expression level of p‐mTOR was significantly lower in resveratrol treatment group and resveratrol+ insulin group than that in I/R group ( P< 0 .05 ) .Conclusions:Resveratrol may protect cardiomyocytes of diabetic rats by activating AMPK pathway ,inhibiting mTOR pathway ,increasing the expression of LC3‐Ⅱ , Atg5 and Beclin‐1 ,promoting autophagy ,suppressing I/R ,and reducing infarction size .