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Relationship Between the Ambulatory Arterial Stiffness Index and Left Ventricular Mass Index, Left Atrial Diameter in Patients With Hypertension

Yuqin LU ; Yingdong LI ; Xinke ZHAO

Chinese Circulation Journal.2014;(6):440-443. doi:10.3969/j.issn.1000-3614.2014.06.012

Objective: To explore the relationship between ambulatory arterial stiffness indexes (AASI), AASI-blood pressure variability (AASI-BPVR) and left ventricular mass index (LVMI) left atrium diameter (LAD) in patients with hypertension.
Methods: A total of 286 hypertensive patients were enrolled in this study. The AASI, AASI-BPVR were calculated from 24-hour ambulatory blood pressure monitoring. Left ventricular internal dimension in diastole (LVIDd), interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), LAD were detected by echocardiography and LVMI, relative wall thickness (RWT) were calculated. The fasting blood glucose, blood lipids were examined. According to 24 h AASI, the patients were divided into 2 groups, Group A, the patients with AASI > 0.51, n=133 and Group B, the patients with AASI ≤ 0.51,n=153. Pearson and multi regression analysis were conducted to analyze the relevant correlations.
Results: Group A had increased LVMI than that in Group B,P<0.05, the left ventricular masses were similar between 2 groups,P=0.384. Pearson correlation analysis indicated that LVMI and LAD were not related to arterial stiffness index, the coefifcient between 24 h-AASI and LAD was atr=0.111,P=0.057.
Conclusion: AASI and AASI-BPVR were not the independent factors for left ventricular hypertrophy and left atrial enlargement, therefore, they were not the predictors for cardiac damage in patients with hypertension at present time.

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The Pathological Processing of Endocannabinoid System on Cardiac Hypertrophy in a Experimental Rats With Chronic Intermittent Hypoxia

Jinyuan ZHANG ; Yan CHEN ; Ling XIAO ; Qian TANG ; Bei WANG ; Yanfeng FAN

Chinese Circulation Journal.2014;(7):545-549. doi:10.3969/j.issn.1000-3614.2014.07.017

Objective: To investigate the effect of endocannabinoid system on cardiac hypertrophy in experimental rats with chronic intermittent hypoxia and to study the impact of endocannabinoid antagonist, rimonabant in such pathological processing.
Methods: A total of 48 male Wistar rats were divided into 6 groups. 4 and 6 weeks of Normal control group, 4 and 6 weeks of Hypoxia group, 4 and 6 weeks of Hypoxia with rimonabant intervention group. n=8 in each group. The rats were sacrificed to measure left ventricular mass index (LVMI), the myocardial cell morphological changes were observed by optical microscope, the expression of cardiac calcium/calmodulin-dependent protein kinase II (CaMKII) and cardiotrophin-1 (CT-1) were detected by immunohistochemistry at 4 and 6 weeks respectively.
Results: Compared with 4 and 6 weeks of Normal control group, the LVMI, cardiac hypertrophy condition, CaMKII and CT-1 were increased in 4 and 6 weeks of Hypoxia group, all P<0.001. Compared with Normal control group and Hypoxia group, the above indexes in Hypoxia with rimonabant intervention group were higher than those in Normal control group while lower than those in Hypoxia group, all P<0.001.
Conclusion: The Chronic intermittent hypoxia could induce myocardial hypertrophy via endocannabinoid system disorders, such pathological processing could be reduced by rimonabant intervention.

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The Regulative Role of ERK5/Bim Pathway in Hypothermal Stimulation Induced Neonatal Rat’s Cardiomyocytes Injury and Apoptosis

Yaosheng WANG ; Xiaoshu CHENG ; Kui HONG ; Zonggui WU ; Yigang LI

Chinese Circulation Journal.2014;(7):540-544. doi:10.3969/j.issn.1000-3614.2014.07.016

Objective: To explore the regulative role of extracellular regulated protein kinase-5 (ERK5)/Bcl-2 interacting mediator of cell death (Bim) pathway in hypothermal stimulation induced neonatal rat’s cardiomyocytes (CMs) damage and apoptosis.
Methods: CMs were cultured for hypothermal stimulation and the speciifc siRNA was used to down-regulate the ERK5 or Bim in CMs. The cell apoptosis was detected by lfow cytometry, protein expression was examined by Western blot analysis, the intracellular Ca2+, reactive oxygen species (ROS) and mitochondrial membrane potential (ΔΨm) were evaluated by lfuorescent labeling and lfow cytometry.
Results: In hypothermal stimulated CMs, ERK5 siRNA could promote Bim protein expression, but Bim siRNA could not inlfuence ERK5, while attenuated p-ERK5 expression. ERK5 siRNA induced higher apoptosis rate, while Bim siRNA could decrease such effect. ERK5 siRNA increased the intracellular Ca2+overloading, ROS activation andΔΨm damage, while Bim siRNA played the role to against those effects in hypothermal stimulated CMs.
Conclusion: Our study revealed that ERK5/Bim pathway played the important regulative roll in hypothermal stimulation induced neonatal rat’s CMs damage and apoptosis.

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Efficacy and Safety Comparison Between Sevoflurane Inhalation Combining Laryngeal Mask Airway and Ketamine Anesthesia for Anesthesia Induction

Pengsheng TIAN ; Quanyi ZHANG ; Chaobin ZHANG ; Jie DING ; Fuxia YAN ; Lihuan LI

Chinese Circulation Journal.2014;(7):537-539. doi:10.3969/j.issn.1000-3614.2014.07.015

Objective: Compared with ketamine anesthesia, to investigate sevoflurane inhalation combining laryngeal mask airway for anesthesia induction in pediatric cardiac surgery.
Methods:A total of 40 pediatric patients with congenital heart diseases received elective cardiac surgery in our hospital from 2013-08 to 2014-01 were studied. The children were from 6 months to 2 years of age and randomly divided into 2 groups, n=20 in each group. Sevolfurane group, the children inhaled the mixture of 8%sevolfurane and 100%O2, laryngeal mask airway was used upon losing consciousness for mechanical ventilation, the anesthesia was maintained by (3-4)% sevolfurane inhalation to facilitate central venous catheter placement. Ketamine group, the children received intramuscular injection of ketamine (7 mg/kg)+atropine (0.01 mg/kg). The peripheral venous line was established upon losing consciousness, the intravenous midazolam (0.1 mg/kg), pipecuronium (0.10 mg/kg), fentanyl (5 μg/kg) were applied, then tracheal intubation was performed for mechanical ventilation and the anesthesia was maintained by (0.5-1)%sevolfurane to facilitate central venous catheter placement.
Results: Sevoflurane group had the shorter time for losing the consciousness than that in Ketamine group (48.90 ± 3.93) s vs (577.85 ± 116.41) s, P<0.05 and the shorter time for ifnishing the central venous catheter placement (11.15 ± 2.48) min vs (24.15 ± 4.02) min, P<0.05. The average blood pressure and heart rate were similar between 2 groups after laryngeal mask or tracheal intubation, P>0.05. The arterial PH value, PaCO2, BE and lactatein were similar between 2 groups, P>0.05.
Conclusion: Sevoflurane inhalation combining laryngeal mask airway could shortening anesthesia preparation time with simple management. It provided an important anesthesia option in pediatric cardiac surgery.

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Analysis of RR-Lorenz Plot in Patients of Sinus Rhythm With Long RR Interval

Jinyi XU ; Yanyan QIU ; Qiong CHEN ; Qingyi WANG ; Yaohan WANG

Chinese Circulation Journal.2014;(7):529-531. doi:10.3969/j.issn.1000-3614.2014.07.013

Objective: To explore the advantage of RR-Lorenz plot (RR-LP) in analyzing the patients of sinus rhythm with long RR interval.
Methods: A total of 308 RR-LP patients with long RR interval were retrospectively studied. The patients were divided into 7 groups according to the type of long RR intervals. ① Sinus bradycardia with arrhythmia group, n=63,②Repeated transient sinus arrest group, n=16, ③Ⅱ° sino-atrial block group, n=14, ④Ⅱ° atrial ventricular block (Ⅱ° AVB) group, n=47, ⑤ Un-passed atrial premature beats (APB) group, n=28, ⑥ Atrial premature beats group, n=72 and ⑦ Premature ventricular beats group, n=68. We analyzed the patients of RR interval greater than 1500 ms with ambulatory electrocardiogram record.
Results: ①RR-LP of sinus bradycardia with arrhythmia group showed a single distributing area with 1500 ms for the origin of transverse and longitudinal axis with B line slope at 1, tilt angle of 45°.②RR-LP of repeated transient sinus arrest,Ⅱ° sino-atrial block,Ⅱ° AVB and APB groups showed special four distributing areas with B line slope at (0.51 ± 0.01), tilt angle of (23.04 ± 0.50) °, B line slope at 0.6, tilt angle of (27°), B line slope at (0.57 ± 0.21), tilt angle of (25.69 ± 9.59)° and B line slope at (0.50 ± 0.01), tilt angle of (22.59 ± 0.54) ° respectively.③RR-LP of premature beats groups showed special four regional distributing areas, B line slope for atrial premature beats was at (0.38 ± 0.12), tilt angle of (17.06 ± 5.22) ° and B line slope for ventricular premature beats was at (0.07 ± 0.05), tilt angle of (3.02 ± 2.39) °.
Conclusion: RR-LP in patients of sinus rhythm with long RR interval had speciifc morphology and distribution features, the local abnormality could be found in a plane via all RR intervals which provided a differential diagnosis for repeated occurrence of short RR interval.

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Preliminary Study for Continuous Subcutaneous Insulin Infusion in Type 2 Diabetes Patients With Heart Diseases

Xiaojue LI ; Yanyan CHEN ; Qiuhong GONG ; Yali AN ; Lihong ZHANG ; Yuanci HUI ; Xiaoxia SHEN ; Xinxing FENG ; Hui WANG ; Guangwei LI

Chinese Circulation Journal.2014;(7):520-524. doi:10.3969/j.issn.1000-3614.2014.07.011

Objectives: To evaluate the effect and safety of 14-day continuous subcutaneous insulin infusion (CSII) in type 2 diabetes patients with heart diseases.
Methods: A total of 22 consecutive type 2 diabetes patients (history ≤ 5 years) with heart diseases treated in our hospital from 2011-03 to 2013-08 were studied. There were 20 male, and the with the mean age of patieuts (48.15 ± 9.80) years, all patients without standard hypoglycemic treatment before admission. The patients received 14-day CSII for enhanced treatment and the blood glucose level, insulin function and insulin sensitivity were compared before and after the treatment.
Results: After CSII treatment, the blood glucose level was obviously decreased, fasting blood glucose (FBG) and postprandial blood glucose at 30, 60 and 120 min were improved, all P<0.001. The C peptide level was higher at 60 and 120 min alter treatweut as 2.73 (1.05-7.05)ng/ml vs 3.84 (1.22-63.39)ng/ml, P=0.004 and 3.34 (1.42-9.61)ng/ml vs 6.27 (0.93-47.39)ng/ml, P=0.004. The insulin sensitivity was improved as -1.89 ± 0.29 vs -1.70±0.31, P=0.008. With CSII treatment, there were 22.73% patients (5/22) at remission by controlling the diet and excise and 77.27% (17/22) with continuing medication. The patients were followed-up for (12.4 ± 8.5) months, there were 4/5 patients with euglycemia, 1/5 with increase blood sugar and received medication at 2 months after discharge, the rest 17 patients remained oral hypoglycemic medication.
Conclusion: CSII may quickly relieve glucotoxicity and improve insulin sensitivity in type 2 diabetes patients with heart diseases. Some patients may alleviate drug burden in clinical practice.

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Clinical Analysis of Hemodynamic Changes in Aged Patients With Essential Hypertension

Ruojun WU ; Bingxue BAI ; Pei SUN ; Xin CHEN ; Qin LI ; Bin LI ; Yazhen WANG

Chinese Circulation Journal.2014;(7):517-519. doi:10.3969/j.issn.1000-3614.2014.07.010

Objective:To explore the hemodynamic changes in aged patients with essential hypertension (EH).
Methods: Our research included 2 groups, EH group, n=180 patients and Control group, n=100 subjects without cardiovascular diseases. The relevant indexes were recorded and compared by BioZ.com noninvasive hemodynamic monitor between 2 groups.
Results: With statistic processing, the cardiac output/index (CO/CI), cardiac index, thoracic lfuid content (TFC), systemic vascular resistance/index (SVR/SVRI) were signiifcantly different between EH group and Control group, all P<0.05.
Conclusion: The hemodynamic changes exist at certain degree indicating the potential injury of cardiac function in aged EH patients, such changes might be helpful for clinical diagnosis and treatment in EH patients.

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Clinical Analysis in Patients of Idiopathic Pulmonary Hypertension With Acute Pulmonary Vasodilator Test

Enci HU ; Zhihong LIU ; Jianguo HE ; Xinhai NI ; Qing GU ; Zhihui ZHAO ; Tao YANG ; Yaguo ZHENG ; Changming XIONG

Chinese Circulation Journal.2014;(7):513-516. doi:10.3969/j.issn.1000-3614.2014.07.009

Objective: To explore the effect of calcium channel blocker (CCB) treatment in patients of idiopathic pulmonary arterial hypertension (IPAH) with positive acute pulmonary vasodilator test, and to compare the hemodynamic differences between the positive and negative patients.
Methods: A total of 156 consecutive IPAH patients with acute pulmonary vasodilator test were studied. The patients were divided into 2 groups according to the testing result. Positive group, n=23 and Negative group, n=133. The positive patients were followed up by clinical or telephone visit to investigate their CCB dose, WHO PAH cardiac classiifcation and the survival conditions. Kaplan-meier curve was conducted to analyze the living condition and t test was used to compare the hemodynamic differences between the positive and negative patients.
Results: There were 43 male and 113 female patients at the male/female ratio of 1: 2.6, and 14.7% (23/156) positive patients. The average follow-up period for Positive group was (50.9 ± 3.8) months. There were 13 patients using diltiazem with the mean dose of (277 ± 108) mg/d at the range of (90-450) mg/d; 3 patients using amlodipine, 1 with the dose of 15mg/d and 2 with the dose of 7.5mg/d. The 1, 2 and 3 years survival rate for the positive patients were for 91.3%, 86.6% and 79.7% respectively. The mean pulmonary arterial pressure and pulmonary vascular resistance were lower, P=0.000, while the mixed venous oxygen saturation was higher in Positive group than Negative group, P=0.009.The NT-pro BNP level was lower in Positive group, P=0.001.
Conclusion: IPAH patients has lower ratio of positive acute pulmonary vasodilator test. The positive patients has the higher 1, 3 and 5 years survival rate and better hemodynamic parameters as the mean pulmonary arterial pressure, pulmonary vascular resistance and better level of NT-pro BNP.

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A Time-series Study for Acute Effect of Air Pollution on Mortality in Patients With Cardio-cerebral Vascular Disease in Tianjin City

Dezheng WANG ; Guohong JIANG ; Qing GU ; Hui ZHANG ; Zhongliang XU ; Guide SONG ; Ying ZHANG ; Chengfeng SHEN

Chinese Circulation Journal.2014;(6):453-457. doi:10.3969/j.issn.1000-3614.2014.06.015

Objective: To explore the acute effect of air pollution on mortality for patients with cardio cerebral vascular disease and to provide the basis for disease prevention and control.
Methods: The Mortality for patients with cardio cerebral vascular disease from 2001-01 to 2009-12 was from Tianjin Centers for Disease Control and Prevention, the meteorological and air pollution data were from Tianjin meteorological bureau and Tianjin environmental monitoring station respectively. The Single and multiple generalized additive model (GAM) extended poisson regression analysis was performed to calculate the relationship between air pollution and cardio-cerebral vascular disease mortality by controlling the time trends, weather, the day of week and air population.
Results: Results: Single GAM analysis indicated that when the effect of SO2, NO2 and PM10 in the air reached the maximum in the day, the RR values for the mortality in patients with cardio-cerebral vascular disease increased 1.13%[95%CI (0.76-1.51)%], 0.78% [95%CI ( 0.41-1.15)%] and 0.61% [95%CI ( 0.51-0.71)%] respectively; when the average concentration of SO2, NO2 and PM10 increasing 10μg/m3 per day, after 0-5 days, the RR values for the mortality elevated 0.70% [95%CI (0.47-0.94)%], 0.51% [95%CI (0.27-0.74)%] and 0.16% [95%CI (0.06-0.27)%] respectively. Multiple GAM analysis presented that when SO2, NO2 and PM10 increasing 10 μg/m3 per day, the RR values for the mortality elevated 0.77% [95%CI (0.58-0.97)%], 0.41% [95%CI (0.05-0.78) %] and 0.38% [95%CI (0.12-0.64%)%] respectively.
Conclusion: The air pollution could increase the mortality risk in patients with cardio-cerebral vascular disease, it is necessary to establish the prevention system in order to decrease the mortality risk in those patients.

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The Influence of Metabolic Syndrome on Coronary Lesions in Elder Patients With Hypertension

Xiaomei SHEN ; Youyou ZHANG ; Wenjie YIN ; Juyan ZHANG

Chinese Circulation Journal.2014;(6):436-439. doi:10.3969/j.issn.1000-3614.2014.06.011

Objective: To evaluate the influence of metabolic syndrome (MS) on coronary lesions in elder patients with hypertension.
Methods: A cohort of 210 hypertensive patients at the age of 60 years or elder who received coronary angiography in our hospital from 2012-06 to 2013-01 were studied. The patients were divided into 2 groups, MS group,n=85 and Non-MS group,n=125 patients without MS. The coronary lesion distribution, number and Gensini score were analyzed and compared between 2 groups.
Results: Compared with Non-MS group, MS group showed increased BMI, TG, HDL-C and fasting blood glucose, allP<0.001. There were no real differences for lesion distribution in left main, left anterior descending branch and the number of patients with normal coronary artery between 2 groups, allP>0.05. MS group had higher Gensini score, more lesions at left circumlfex and right coronary artery, more patients with coronary lesions and more patients with 3-branch disease,P<0.05. Logistic regression analysis indicated that MS is the independent risk factor for coronary lesions and the risk is higher than any single components of MS.
Conclusion: MS is related to the severity of coronary lesions in elder patients with hypertension.

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