Coronary Artery Disease: Li Y

Hirayama A, Saito S, Ueda Y, Takayama T, Honye J, Komatsu S, Yamaguchi O, Li Y, Yajima J, Nanto S, Takazawa K, Kodama K. · Division of Cardiology, Department of Medicine, Nihon University School of Medicine, and Department of Cardiology, The Cardiovascular Institute Hospital, Tokyo, Japan. · Circ J. · Pubmed #19225206 links to  free full text

Abstract: BACKGROUND: The aim of this study was to elucidate the time course of atorvastatin-induced changes in vulnerable plaque using angioscopy and intravascular ultrasound (IVUS). METHODS AND RESULTS: Fifty-seven hypercholesterolemic patients with coronary artery disease (CAD) were treated with atorvastatin (10-20 mg/day) for 80 weeks and then coronary plaques were evaluated with angioscopy and IVUS. Angioscopic images were classified into 6 grades (0-5) based on yellow color intensity. A 20-mm segment containing angioscopically-identified yellow plaque was also examined by IVUS to measure atheroma volume. The mean angioscopic grade of 58 yellow plaques significantly decreased from 1.5 (95% confidence interval [CI] 1.2 to 1.8) to 1.1 (95%CI 0.9 to 1.3, P=0.012) at week 28 and 1.2 (95%CI 0.9 to 1.4, P=0.024) at week 80. Mean volume of 30 lesions, including the 58 yellow plaques, significantly reduced -8.3% (95%CI -11.5 to -5.2) at week 28 (P<0.001 for baseline vs week 28) and -17.8% (95%CI -23.9 to -11.8) at week 80 (P<0.001 for baseline vs week 80). CONCLUSIONS: In patients with CAD treated with atorvastatin, serial analysis with angioscopy demonstrated early loss of yellow color in plaques, and IVUS volumetric analysis showed subsequent plaque regression. Both changes possibly indicate reduction of plaque vulnerability in an additive manner.

Han YL, Wang B, Wang XZ, Li Y, Wang SL, Jing QM, Wang G, Ma YY, Luan B. · Department of Cardiology, Shenyang General Hospital of PLA, Shenyang, Liaoning 110016, China. · Chin Med J (Engl). · Pubmed #19102953 links to  free full text

Abstract: BACKGROUND: Rapid recanalization of infarct-related artery (IRA) has become the major target during primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (MI), but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease. METHODS: A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries (luminal narrowing > or = 70%) undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only (group 1), and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction (AMI) (group 2). Drug-eluting stents (DESs) were deployed in more than 90% of the patients. RESULTS: The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events (11.5% vs 15.1%, P > 0.05) and target lesion revascularization (8.1% vs 7.6%, P > 0.05) between the two groups. However, patients in group 1 had higher rates of recurrent angina (10.1% vs 2.1%, P < 0.05) and depressed left ventricular ejection fraction evaluated by echocardiography (0.56 +/- 0.22 vs 0.63 +/- 0.25, P < 0.05). CONCLUSION: With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation MI and multi-vessel disease.

Han YL, Su QF, Li Y, Wang SL, Jing QM, Ma YY, Wang ZL, Wang DM, Luan B. · Cardiovascular Research Institute, Department of Cardiology, General Hospital of Shenyang Command, People's Liberation Army, Shenyang 110016, China. · Zhonghua Yi Xue Za Zhi. · Pubmed #16796832 No free full text.

Abstract: OBJECTIVE: To evaluate short-term efficacy and safety of triple antiplatelet regimen (cilostazol combined with clopidogrel and aspirin) in patients who underwent percutaneous coronary intervention (PCI). METHODS: From October 2001 to April 2005, a total of 3135 patients underwent PCI in the General Hospital of Shenyang Command, People's Liberation Army, of which 1103 were treated with cilostazol 100 mg twice a day for 6 months in addition to aspirin and clopidogrel for 3 - 12 months as triple antiplatelet therapy regimen (triple group) after PCI, and 2032 of which received aspirin and clopidogrel for 3 - 12 months as dual antiplatelet therapy regimen after PCI (control group). The data of the incidence rates of major adverse cardiac events (MACE), subacute in-stent thrombosis (SAT), and hemorrhage events within 30 days after PCI of the two groups were retrospectively analyzed. RESULTS: The baseline clinical characteristics were comparable between these two groups. However, the proportions of the patients receiving stent implantation, with multivessel coronary artery diseases, and receiving PCI for unprotected left main trunk diseases of the triple group (91.3%, 68.3%, and 7.1% respectively) were all significantly higher than those of the control group (89.1%, 63.3%, and 4.6%, P < 0.05, P < 0.01, and P < 0.01). The proportion of patients with chronic total occlusions who received PCI in the triple group was 10.8%, significantly lower than that of the control group (13.4%, P < 0.05). No death occurred during procedure in both groups. The 30 d mortality and the rate of MACE with 30 days after PCI of the triple group were 0.4% and 1.3%, both significantly lower than those of the control group (1.6%, and 2.6%, both P < 0.05). However, there were no significant differences in the incidence rates of SAT and major hemorrhage events between these 2 groups (0.7% vs 1.0% and 0.3% vs. 0.2% respectively, both P > 0.05). CONCLUSION: This novel triple antiplatelet regimen (aspirin and clopidogrel combined with cilostazol) for PCI patients is safe and more efficient than the dual antiplatelet therapy regimen (clopidogrel and aspirin) in reducing mortality and incidence of MACE in a short-term period.

Li Y, Zheng Z, Xu B, Zhang S, Li W, Gao R, Hu S. · Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China. · Circulation. · Pubmed #19349321 No free full text.

Abstract: BACKGROUND: Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003, drug-eluting stents were introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery. The long-term outcome of drug-eluting stents compared with that of CABG surgery is also unclear. METHODS AND RESULTS: We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction, and stroke) and efficacy (target-vessel revascularization) during a 3-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors. Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients receiving drug-eluting stents had considerably higher 3-year rates of target-vessel revascularization. Drug-eluting stents were also associated with higher rates of death (adjusted hazard ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and myocardial infarction (adjusted hazard ratio, 1.65; 95% confidence interval, 1.15 to 2.44). The risk adjusted rate of stroke was similar in the 2 groups (hazard ratio, 0.92; 95% confidence interval, 0.69 to 1.51). CONCLUSIONS: In a cohort of patients with multivessel disease, CABG was associated with lower rates of death, myocardial infarction, and target-vessel revascularization than drug-eluting stents.

Fu SP, Zheng Z, Yuan X, Zhang SJ, Gao HW, Li Y, Hu SS. · Chinese Academy of Medical Science, Peking Union Medical College, Fuwai Hospital & Cardiovascular Institute, Department of Surgery, Research Center for Cardiovascular Regenerative Medicine, Beijing, People's Republic of China. · Ann Thorac Surg. · Pubmed #19324133 No free full text.

Abstract: BACKGROUND: Off-pump coronary artery bypass graft surgery (OPCAB) is associated with lower early mortality and benefits women disproportionately. The objective of this study was to assess the impact of off-pump techniques on sex differences in late outcomes. METHODS: We reviewed a clinical database of consecutive patients who underwent isolated coronary artery bypass graft surgery (CABG) at FuWai Hospital from 1999 to 2005. Logistic regression analysis and proportional hazards modeling were used to investigate whether sex or surgery type were associated with early mortality and late outcomes (mortality, major cardiac and cerebral event). RESULTS: Female sex was associated with higher rates of early death (adjusted odds ratio, 4.726; p < 0.0001), and OPCAB benefited women disproportionately for early mortality. Odds ratio of death for women versus men was 4.726 (p < 0.0001) in the conventional CABG on cardiopulmonary bypass group; odds ratio of death for women versus men was 1.344 (p = 0.5617) in the OPCAB group. Analysis of late outcomes indicated that OPCAB and cardiopulmonary bypass resulted in similar survival, regardless of sex. The women versus men hazard ratio of late mortality after CABG on cardiopulmonary bypass and OPCAB for women was 0.851 (p = 0.4984) and 0.650 (p = 0.2005), respectively. Women treated with OPCAB were less likely to be free from major cardiac and cerebral events than men treated with OPCAB. The women versus men hazard ratio of major cardiac and cerebral events after CABG on cardiopulmonary bypass and OPCAB for women was 1.079 (p = 0.4992) and 1.299 (p = 0.0387), respectively. CONCLUSIONS: Compared with men, women are a high-risk group and benefit from off-pump operation in terms of early mortality after CABG. Conversely, during follow-up, women have high adjusted risks of major cardiac and cerebral events after OPCAB.

Lin Y, Zheng Z, Li Y, Yuan X, Hou J, Zhang S, Fan H, Wang Y, Li W, Hu S. · Department of Cardiovascular Surgery and Research Center for Cardiovascular Regenerative Medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. · Ann Thorac Surg. · Pubmed #19324131 No free full text.

Abstract: BACKGROUND: Preoperative renal dysfunction has been an important predictor for adverse cardiovascular events after coronary artery bypass grafting (CABG). In the past, serum creatinine was widely used to assess renal function. Until recently, estimated glomerular filtration rate (eGFR) was recommended in evaluating renal function. The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD) equation are two widely used formulas in clinical practice. Which method best predicts long-term outcome after CABG is still unknown. This study compared the predictive effectiveness of the Cockcroft-Gault formula, the MDRD equation, and serum creatinine level for in-hospital and long-term mortality. METHODS: We retrospectively reviewed data collected from 5559 patients who underwent isolated CABG at Fuwai Hospital from January 1999 to December 2005. The main outcomes were in-hospital and long-term mortality. Receiver operating characteristic (ROC) curves and Cox analysis were used for the comparison. RESULTS: Mean follow-up was 56.5 +/- 24.6 months. ROC curve analysis showed that the Cockcroft-Gault formula had the greatest accuracy for predicting in-hospital mortality (area under the curve, 0.755; p < 0.001). Multivariate analysis confirmed that the eGFR based on the Cockcroft-Gault formula was an independent predictor of in-hospital (odds ratio, 4.51, p < 0.001) and long-term (hazard ratio, 1.54; p = 0.003) mortality. Both formulas were better than the serum creatinine level. CONCLUSIONS: Both formulas could provide a better measure of risk assessment than serum creatinine for in-hospital and long-term mortality. The Cockcroft-Gault formula was better than the MDRD equation for predicting in-hospital mortality.

Han YL, Zhang J, Li Y, Wang SL, Jing QM, Yi XH, Ma YY, Luan B, Wang G, Wang B. · Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning 110016, China. · Chin Med J (Engl). · Pubmed #19323927 links to  free full text

Abstract: BACKGROUND: There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation. METHODS: Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method. RESULTS: Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4 +/- 2.5) months vs (1.7 +/- 0.8) months, P < 0.001). Average follow-up periods were (4.7 +/- 0.89) and (3.2 +/- 1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P = 0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P < 0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P < 0.001). The rates of re-admission caused by cardiovascular disease (27.0% vs 37.8%, P < 0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P < 0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% CI 0.396 - 0.656, P < 0.001). Left ventricular ejection fraction < 50% and elderly (> or = 65 years) were identified as independent predictors of long-term MACE during follow-up. CONCLUSION: This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery.

Chen M, Wang J, Xie M, Wang X, Lv Q, Wang L, Li Y, Fu M. · Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan, China. · J Huazhong Univ Sci Technolog Med Sci. · Pubmed #19224178 No free full text.

Abstract: Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardiography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controls (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocardiography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups (P<0.01). There was no significant difference in NC group (P>0.05), but significant difference in HHD and CAD intra-group (P<0.05). There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups (r=0.69, P<0.01; r=0.68, P<0.01), but no significant correlation in CAD group (r=0.30, P>0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Okada H, Takemura G, Kosai K, Tsujimoto A, Esaki M, Takahashi T, Nagano S, Kanamori H, Miyata S, Li Y, Ohno T, Maruyama R, Ogino A, Li L, Nakagawa M, Nagashima K, Fujiwara T, Fujiwara H, Minatoguchi S. · Division of Cardiology, Gifu Univ. Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan. · Am J Physiol Heart Circ Physiol. · Pubmed #19151252 No free full text.

Abstract: We hypothesized that therapy, composed of antiapoptotic soluble Fas (sFas) gene transfer, combined with administration of the cardioprotective cytokine granulocyte colony-stimulating factor (G-CSF), would markedly mitigate cardiac remodeling and dysfunction following myocardial infarction (MI). On the 3rd day after MI induced by ligating the left coronary artery in mice, four different treatments were initiated: saline injection (Group C, n = 26); G-CSF administration (Group G, n = 27); adenoviral transfer of sFas gene (Group F, n = 26); and the latter two together (Group G+F, n = 26). Four weeks post-MI, Group G+F showed better survival than Group C (96 vs. 65%, P < 0.05) and the best cardiac function among the four groups. In Group G, the infarct scar was smaller and less fibrotic, whereas in Group F the scar was thicker, without a reduction in area, and contained abundant myofibroblasts and vascular cells; Group G+F showed both phenotypes. G-CSF exerted a beneficial effect on infarct tissue dynamics through antifibrotic and proliferative effects on granulation tissue; however, it also exerts an adverse proapoptotic effect that leads to thinning of the infarct scar. sFas appeared to offset the latter drawback. In vitro study using cultured myofibroblasts derived from the infarct tissue revealed that G-CSF increased proliferating activity of those cells accompanying activation of Akt and signal transducer and activator of transcription 3, while accelerating Fas-mediated apoptosis with increasing Bax-to-Bcl-2 ratio. The results suggest that combined use of G-CSF administration and sFas gene therapy is a potentially powerful tool against post-MI heart failure.

Han Y, Wang S, Jing Q, Li Y, Liu H, Ma Y, Wang Z, Wang D, Luan B, Wang G, Chen T. · Department of Cardiology, Shenyang Northern Hospital, Shenyang, 110016, China. · Am J Cardiol. · Pubmed #19121435 No free full text.

Abstract: The use of paclitaxel-eluting stents (PES) for the treatment of unprotected left main coronary artery (LMCA) disease is controversial. Between January 2003 and December 2006, a total of 287 patients undergoing percutaneous coronary intervention for LMCA lesions were consecutively registered. Of those patients, 178 received PES and 109 received bare-metal stents (BMS). Estimated perioperative mortality rates were 7.3% and 6.8% for the BMS and PES groups, respectively (p=0.51). PES recipients had distal left main bifurcation lesions more frequently compared with BMS recipients (72 vs 42%, p<0.01). At an average follow-up of 35 months, the rates of major adverse cardiac events (4.5 vs 23.9%, adjusted odds ratio [OR] 0.23, 95% confidence interval [CI] 0.09 to 0.58, p<0.001) and target-lesion revascularization (2.2 vs 13.8%, adjusted OR 0.26, 95% CI 0.08 to 0.83, p<0.001) were significantly lower in the PES group than in the BMS group. Overall thrombotic event rates were 1.1% and 4.6% in the PES and BMS groups, respectively (p=0.08). Angiographic follow-up was performed in 61% and 59% of PES and BMS recipients, respectively. The angiographic restenosis rate was significantly lower in the PES group as compared with the BMS group (3.7 vs 23.4%, p<0.001). In conclusion, PES implantation provides a safe, effective therapy for unprotected LMCA disease and decreases the risk of major adverse cardiac events compared with BMS at a mean follow-up of 35 months.

Yuan X, Zheng Z, Li Y, Hu S. · Department of Cardiovascular Surgery, Center for Cardiovascular Regenerative Medicine, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. · Heart Surg Forum. · Pubmed #19073531 No free full text.

Abstract: BACKGROUND: This research was aimed at validating a new risk model for in-hospital mortality in Chinese patients undergoing coronary artery bypass graft (CABG) surgery. This model (NYS), which was developed for isolated CABG surgery from data of New York's cardiac surgery reporting system in 2002, was proved effective, but its validation in Chinese patients has yet to be carried out. METHODS: The original model was recalibrated, and the fitness of the recalibrated model was tested in the Chinese Coronary Artery Bypass Graft Registry. From January 2004 to December 2005, 9248 patients undergoing CABG were enrolled in the Chinese CABG Registry, and 8120 patients who underwent isolated CABG were selected for the current study. RESULTS: The C statistic value for the original model was 0.74 (95% confidence interval [CI], 0.70-0.78), and the chi2 statistic was >26.13 (P < .001), indicating a necessity for recalibration. The fit of the recalibrated model was satisfactory (C statistic, 0.74 [95% CI, 0.70-0.78]; chi2 = 5.98; P = .65). Furthermore, translation of risk profiles into NYS scores revealed strong correlations between risk-score levels and different end points, including in-hospital mortality, major adverse cardiac events, and length of intensive care unit stay. Independent predictors were identified in the Chinese CABG Registry. Many predictors for the Chinese CABG Registry were the same as those in the NYS model. CONCLUSIONS: The original NYS system overestimates in-hospital mortalities in Chinese patients undergoing CABG, whereas the recalibrated model corrects such overestimations. This model can be a useful risk-predictive tool for Chinese patients undergoing isolated CABG.

Wang H, Tang W, Ristagno G, Li Y, Sun S, Wang T, Weil MH. · Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA. · Crit Care Med. · Pubmed #19050623 No free full text.

Abstract: OBJECTIVE: In the last two decades, the incidence of ventricular fibrillation has significantly decreased as the presenting rhythm in sudden cardiac arrest. We hypothesized that beta-adrenergic receptor blocker (beta-blocker) and angiotensin converting enzyme inhibitor, which were commonly used in the primary and secondary prevention strategies recommended by the American Heart Association during the same decades, decrease the duration of ventricular fibrillation after onset of cardiac arrest. DESIGN: Randomized prospective animal study. SETTING: University affiliated research laboratory. SUBJECTS: Male Sprague-Dawley rats. METHODS AND RESULTS: Male Sprague-Dawley rats, weighing 450-550 g were administered either beta-blocker, propranolol, angiotensin converting enzyme inhibitor, captopril, or placebo for 2 wks. In the phase 1 study, ventricular fibrillation was induced by ligation of the proximal left coronary artery. In the phase 2 study, the experiments were repeated with the measurements of duration of monophasic action potential and threshold of ventricular fibrillation. Both propranolol and captopril significantly decreased the duration of ventricular fibrillation in comparison with controls (p < 0.05). In the phase 2 study, both propranolol and captopril significantly increased the threshold of ventricular fibrillation (p < 0.05) and monophasic action potential (p < 0.05). CONCLUSIONS: Ventricular fibrillation remains as the leading causal rhythm of sudden cardiac arrest. However, the drugs widely used in primary and secondary coronary artery disease prevention strategies shortened the duration of ventricular fibrillation. This may result in the reduced incidence of ventricular fibrillation as the presenting rhythm in sudden cardiac arrest. Increased threshold of ventricular fibrillation and monophasic action potential after administration of those agents may be the potential mechanisms of reduced duration of ventricular fibrillation.

Liu X, Li Y, Wang L, Zhao Q, Lu X, Huang J, Fan Z, Gu D. · Department of Evidence Based Medicine and Division of Population Genetics, Cardiovascular, Institute, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China. · Thromb Haemost. · Pubmed #18989534 No free full text.

Abstract: Dyslipidemia, especially hypercholesterolemia, is a major risk factor of coronary heart disease (CHD). The insulin induced gene 1 (INSIG1) and insulin induced gene 2 (INSIG2) encode two proteins which mediate feedback control of cholesterol synthesis. We conducted a case-control study to investigate whether the common variants in INSIG genes were associated with CHD in Chinese Han population. Three single nucleotide polymorphisms (SNPs) of the INSIG1 gene and four SNPs of the INSIG2 gene were chosen as haplotype-tagging SNPs (htSNPs) and genotyped in 853 patients with CHD and 948 unrelated control subjects. Haplotype analysis showed that the haplotype Hap4 (TTA) of the INSIG1 gene significantly increased the risk of CHD (adjusted odds ratio [OR]1.59, 95% confidence interval [CI] 1.22-2.06, p = 0.0006), while the haplotype Hap3 (TGA) significantly decreased the risk of CHD (adjusted OR 0.74, 95%CI 0.60-0.92, p = 0.006) compared with the reference haplotype Hap1 (GGA). No significant associations were found between polymorphisms of INSIG2 gene and CHD. In addition, the single polymorphism analysis showed that rs9769826 of the INSIG1 gene was associated with glucose in controls. The G-allele (minor allele) carriers had higher glucose level (5.74 +/- 2.03 mM) than AA genotype carriers (5.45 +/- 1.37 mM, p = 0.015). The present study indicated that the INSIG1 gene, but not the INSIG2 gene, was associated with CHD in the Chinese population.

Schindler TH, Facta AD, Prior JO, Cadenas J, Zhang XL, Li Y, Sayre J, Goldin J, Schelbert HR. · Department of Molecular and Medical Pharmacology, Radiological Science, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 23-120 CHS, P.O. Box 173517, Los Angeles, CA 90095-1735, USA. · Eur J Nucl Med Mol Imaging. · Pubmed #18704406 No free full text.

Abstract: PURPOSE: To determine the relationship between carotid intima-media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM). METHODS: In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with (13)N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation. RESULTS: There was neither a relationship between carotid IMT and CAC (r = 0.10, p = 0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r = -0.18, p = 0.25 and r = 0.10, p = 0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44 +/- 18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69 +/- 0.24 vs. 0.74 +/- 0.23 and 1.82 +/- 0.50 vs. 1.95 +/- 0.51 ml/g/min; p < or = 0.05, respectively) and also during CPT in DM but less pronounced (0.81 +/- 0.24 vs. 0.83 +/- 0.23 ml/g/min; p = ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r = -0.36, p < or = 0.014; r = -0.46, p < or = 0.007; and r = -0.33, p < or = 0.041, respectively). CONCLUSIONS: The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall.

Long Y, Mi Y, Li Y. · Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China. · Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. · Pubmed #18693457 No free full text.

Abstract: This review aims to evaluate the quality of studies assessing the value of 99mTc-MIBI myocardial perfusion imaging in the diagnosis of coronary artery disease. OVID (1956 to 2006), CBMdisc (1978 to 2006), CNKI (2005 to 2006) and VIP (2005 to 2006) for relevant studies in English and Chinese were searched and identified. Quality assessment of diagnostic accuracy studies (QUADAS) items were used. Studies were classified and Meta-disc software was used to analyze sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for the pooled analysis and heterogeneity test, then Asymmetric SROC curves were drawn for those without heterogeneity. In 29 articles included, the results of the pooled analysis showed that, as for rest, exercise and drug myocardial perfusion imaging, the pooled LR + were 2.209, 4.334 and 5.508, the pooled LR- were 0.224, 0.141 and 0.195, and for dipyridamole myocardial perfusion imaging, the pooled LR+ and LR- were 5.031 and 0.193, respectively. Besides, for stress myocardial perfusion imaging among the patients without myocardial infarction history, the pooled LR+ and LR- were 6.176 and 0.199, respectively. The biases from the 29 studies were mainly due to diagnostic test results review bias; variations were probable and were correlated with the spectrum of disease and inclusion criteria; the quality of report was moderate. The conclusion is that 99mTc-MIBI stress MPI, especially dipyridamole MPI, is valuable for diagnosing coronary artery disease.

Wu L, Xu DL, Deng LH, Ye TC, Deng H, Li Y. · Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. · Nan Fang Yi Ke Da Xue Xue Bao. · Pubmed #18676273 links to  free full text

Abstract: OBJECTIVE: To analyze the patterns of serum soluble CD14 (sCD14) and C-reactive protein (CRP) alterations in patients with chronic heart failure (CHF) and investigate the correlations of sCD14 variation to the etiology, clinical symptoms, and the number of mononuclear cells in these patients. METHODS: This study involved 246 CHF patients stratified according to their etiology and clinical symptoms, with 107 normal individuals serving as the control group. Blood samples were collected from these patients the next day after admission and also from the control subjects for measuring serum sCD14 and CPR levels using enzyme-linked immunosorbent assay (ELISA) and rate nephelometry, respectively. RESULTS: The CHF patients had significantly higher serum levels of sCD14 and CRP than the control subjects (P<0.01). In the CHF patients, serum sCD14 and CRP levels differed significantly in the patients with clinical symptoms of different severities (F=3.787, P=0.024), and those with moderate and severe symptoms had significantly higher levels than the asymptomatic patients (P<0.05). The difference in etiologies also resulted in significant difference in sCD14 levels (P<0.05), which were significantly lower in coronary artery disease group than in hypertension group (P<0.05). Significant positive correlations were found between sCD14 and the CRP levels in the CHF patients (r=0.227, P=0.018) and between sCD14 level and the clinical symptoms (r=0.206, P=0.001), but sCD14 level was not correlated to the absolute or relative number of mononuclear cells. CONCLUSIONS: Serum sCD14 and CRP levels are significantly elevated in CHF patients, but this condition may vary as the etiologies and clinical symptoms differ. Increased mononuclear cells do not contribute to the elevation of serum sCD14.

Li Y, Glance LG, Cai X, Mukamel DB. · Department of Medicine, ECMC, Clinical Center CC-163, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA. · Health Serv Res. · Pubmed #18665856 No free full text.

Abstract: CONTEXT: Patients with mental disorders show higher burden of coronary heart disease, and may face special safety issues during in-hospital cardiac care. OBJECTIVES: To compare the postoperative complication rate between patients with and without mental disorders undergoing isolated coronary artery bypass graft (CABG) surgery. DESIGN, SETTING, AND PATIENTS: Retrospective analyses of New York state hospital claims between 1997 and 2004 (N=135,701). Complications were defined using the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ PSI). PRINCIPAL FINDINGS: Mental disorders were significantly associated with higher anesthesia complications (adjusted odds ratio [AOR]=6.44, p < .001), decubitus ulcer (AOR=1.42, p = .006), postoperative hip fracture (AOR = 3.29, p < .001), and overall complication rate representing nine PSIs (AOR = 1.27, p < .001). CONCLUSIONS: Mentally ill patients undergoing CABG surgery are more likely to experience potentially preventable complications and injuries. The mechanism underlying this observation warrants further study.

Han Y, Jing Q, Chen X, Wang S, Ma Y, Liu H, Luan B, Wang G, Li Y, Wang Z, Wang D, Xu B, Gao R. · Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning, China. · Catheter Cardiovasc Interv. · Pubmed #18655114 No free full text.

Abstract: BACKGROUND: The residual drug carriers on drug-eluting stents (DES) surfaces are considered to be one of the most significant reasons causing late thrombosis. There is no documented data currently available on the safety/benefit profile beyond 6 months of EXCEL stent, a novel sirolimus-eluting stent with biodegradable polymer coating, in treating patients with coronary artery disease (CHD). OBJECTIVE: To evaluate the long-term efficacy and safety of EXCEL stent on treating CHD patients. METHODS: Between February and March 2006, a consecutive cohort of complex patients treated with the EXCEL stent was prospectively enrolled in this single-center registry. Antiplatelet protocol was 6-month dual antiplatelet therapy with clopidogrel and aspirin followed by aspirin alone indefinitely. The primary outcome was major adverse cardiac events (MACE) at 12 months. Secondary outcomes included in-segment and in-stent late lumen loss and binary restenosis rate measured by quantitative coronary angiography (QCA) analysis at 8 months postindex PCI procedure. RESULTS: A total of 100 patients with 153 lesions were included in this analysis. Most lesions (83.0%) were classified as complex (B2/C). At 12 months, four patients (4.0%) experienced MACE, which were four target-lesion revascularizations due to in-stent restenosis (ISR). All patients received follow-up up to 24 +/- 0.4 months and no cardiac death, MI, and in-stent thrombosis occurred during the 6 months of dual antiplatelet therapy or the subsequent 15 months of aspirin treatment alone. QCA analysis of 112 lesions from 75 patients showed 3.6% (4/112) in-stent lesion restenosis, 5.4% (6/112) in-segment lesion restenosis, 0.12 +/- 0.34 mm in-stent late lumen loss, and 0.08 +/- 0.35 mm in-segment late lumen loss. CONCLUSIONS: In this single-center experience with complex patients and lesions, the EXCEL stent implantation with 6-month dual antiplatelet treatment proved to markedly reduce the incidence of 24-month ISR and MACE. These preliminary findings require further validation by large scale, randomized trials.

Qian Q, Chen Z, Ma G, Jiang Y, Feng Y, Shen C, Yao Y, Ding J, Dai Q, Li Y. · Clinical Medical College of Southeast University, Nanjing, 210009, People's Republic of China. · Mol Biol Rep. · Pubmed #18604638 No free full text.

Abstract: BACKGROUND: Inflammation plays an important role in coronary artery disease (CAD). Complement Factor H (CFH) gene has been analyzed in relation to CAD in several studies with conflicting results. The aim of the present study was to investigate the association between the CFH Y402H polymorphism and CAD in Chinese. METHODS AND RESULTS: About 336 patients were enrolled, included 166 patients with CAD and 170 controls. The SNP at CFH Y402H was genotyped by ligase detection reaction and plasma levels of CFH were assayed by enzyme-linked immunosorbent assay. Analysis of genotype frequencies did not reveal any significant difference between CAD patients and controls. There were significant differences in the frequencies of C allele and C allele carriers between early-onset CAD and controls. After adjustment of clinical parameters, significant association was identified for CFH Y402H polymorphism, with C allele carriers having a higher risk of early-onset CAD than carriers of TT genotype (odds ratio [OR] 4.66, 95% CI: 1.23-17.62, P = 0.02). There was no difference of plasma CFH levels between CAD group and controls. CONCLUSIONS: CFH Y402H polymorphism is associated with early-onset CAD in Chinese.

Ma ES, Yang ZG, Yu JQ, Li Y, Bai HL, Li ZL. · Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China. · Sichuan Da Xue Xue Bao Yi Xue Ban. · Pubmed #18575351 No free full text.

Abstract: OBJECTIVE: To study the clinical value of coronary artery calcification score with 64-slice MDCT in the diagnosis of coronary artery disease (CAD). METHODS: 96 subjects including 49 with confirmed CAD (CAD group) and 47 asymptomatic people as control group were recruited between May 2006 and December 2006 by the department of radiology in our hospital. The selective coronary angiography was also performed in 30 subjects including 25 with CAD and 5 asymptomatic people and subsequently divided into three groups (< 50%, 50%-75% and > 75% of maximum degree of vessel occlusion). We investigated the correlation of calcification score (CS) and the maximum degree of vessel occlusion measured by coronary angiography were investigated. RESULTS: The larger CS and more numbers of regions of interest of calcification in the right coronary artery and left anterior descending artery in 96 subjects were observed. The total mean CS of CAD (462 +/- 314) was higher than that of control group (83 +/- 52) (P < 0.001). There was a moderate correlation between degree of vessel stenosis and CS for individual vessels in patients with positive calcium scan(r = 0. 445, P < 0.01). CONCLUSION: Although CS measured by MDCT is not an accurate marker of the degree of vessel stenosis in CAD, it can be applied as a screening tool for high risk CAD patients and could greatly reduce the expense on coronary angiography.

Wang Y, Li Y. · Department of Geriatrics, Xinhua Hospital, Shanghai Jiaotong University, Shanghai 200092, China. · Zhonghua Nei Ke Za Zhi. · Pubmed #18478911 No free full text.

Abstract: OBJECTIVE: To explore the relationship between microalbuminuria and the severity of coronary stenosis in patients with coronary heart disease. METHODS: 169 consecutive patients with coronary artery disease were divided into non-DM group and DM (diabetes mellitus) group. All the patients underwent coronary angiography (CAG) and echocardiography. Urinary albumin to creatinine ratio, BMI, serum creatinine, fasting blood glucose, 2-hour blood glucose, TC, LDL, HDL, TG etc were determined. The coronary artery changes were analysed with CAG. The severity of coronary artery lesion was evaluated by the numbers of diseased vessels and coronary artery stenosis score (6-step evaluation standard according to AHA). The risk factors of coronary artery lesion were analysed by stepwise multiple regression analysis. RESULTS: (1) In the non-DM group, a microalbuminuria (MA) subgroup had significantly higher coronary artery stenosis score and number of diseased vessels as compared with a non-MA subgroup (7.90 +/- 3.07 vs 5.77 +/- 2.87, P < 0.05; 1.84 +/- 0.17 vs 1.38 +/- 0.93, P < 0.05). Stepwise multiple regression analysis showed MA, male gender, LDL-C, EF were independent predictors of coronary artery stenosis score. (2) In the DM group, a MA subgroup also had significantly higher coronary artery stenosis score and number of diseased vessels as compared with a non-MA subgroup (8.15 +/- 3.4 vs 5.86 +/- 3.06, P < 0.05; 2.03 +/- 0.91 vs 1.51 +/- 0.76, P < 0.05). However, stepwise multiple regression analysis showed only MA and male gender were independent predictors of coronary artery stenosis score. CONCLUSION: The screening of MA in CHD helps to find out the patients with severe coronary artery lesion and worse prognosis.

He H, Shi M, Zeng X, Yang J, Li Y, Wu L, Li L. · Institute of Chinese Herbal Medicine, College of Pharmaceutical Sciences, Zijingang Campus, Zhejiang University, Hangzhou, China. · J Ethnopharmacol. · Pubmed #18439775 No free full text.

Abstract: AIM: To study the cardioprotective effect of salvianolic acid B (Sal B) on cardiac dysfunction. We hypothesized that hyperleptinemia may correlate with abnormal expression of sarco/endoplasmic reticulum ATPase 2a (SERCA2a), phospholamban (PLB) and endothelin-reactive oxygen species (ET-ROS) pathways in rats with large myocardial infarction (MI). METHODS: Large MI was produced by coronary artery ligation for 4 weeks in rats. The rats were divided into four groups: sham, MI, MI+l-Sal B (50 mg/(kg d)), p.o. for 4 weeks), and MI+h-Sal B (100 mg/(kg d)), p.o. for 4 weeks). RESULTS: In MI rats, hemodynamic and echocardiographic abnormalities, cardiac remodeling, and histological changes with features of cardiac failure were associated with hyperleptinemia accompanied by oxidative stress and upregulated OB-Rb, ET pathway mRNA expression and downregulated SERCA2a and PLB mRNA and protein expressions in the myocardium. CONCLUSIONS: The studies demonstrated that an activated leptin pathway correlated with abnormal expression of SERCA2a, PLB and an activated ET-ROS system in the affected myocardium. Sal B exerts beneficial actions on cardiac function in rats with large MI, mainly suppressing upregulation of leptin and ET pathways and oxidative stress, and recovering the normal expressions of SERCA2a and PLB in myocardium.

Li Y, Yang L, Wang XJ, Zhao XH, Zhao LF. · Radiology Department, General Hospital of PLA, Beijing 100853 , China. · Zhonghua Yi Xue Za Zhi. · Pubmed #18396616 No free full text.

Abstract: OBJECTIVE: To evaluate the diagnostic accuracy of 64 multislice computed tomography (MSCT) coronary angiography on the coronary atherosclerosis. METHODS: Sixty one (52 male, 9 female, averaged 58 +/- 11 yrs ) patients underwent conventional coronary angiography and 64-MSCT angiography for suspected coronary artery disease within 5 to 20 days. Coronary artery image quality was scored from 1 to 4 (image quality score, 1: poor; 2: good -; 3: good +, and 4: excellent) on RCA, LM, LAD and LCX, respectively. The coronary artery stenosis were divided into two groups by over than 50% and less than 50% and diagnostic accuracy was analyzed. The coronary plaques were divided as calcified and noncalcified plaque according to its density. The stenosis result from calcified and noncalcified plaque were analyzed. RESULTS: Mean score of image quality on RCA, LM, LAD and LCX was 3.57 +/- 0.18 with heart beats 50 - 104 bpm (mean 70 +/- 11 bpm). Compared with CAG, the sensitivity and specificity of 64-MSCT in evaluating stenosis are 94.45% and 96.15%, the false positive and false negative value are 3.85% and 4.55%. The sensitivity and specificity were 85.71% in evaluating stenosis result from noncalcified plaque and they were 83.33% and 31.57% result from calcified plaque. CONCLUSION: 64-MSCT is an accurate and feasible method in evaluating coronary artery stenosis compared to conventional coronary angiography. However the specificity was poor in evaluating calcified plaque.

Yao K, Huang R, Qian J, Cui J, Ge L, Li Y, Zhang F, Shi H, Huang D, Zhang S, Sun A, Zou Y, Ge J. · Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. · Heart. · Pubmed #18381377 No free full text.

Abstract: BACKGROUND: Regeneration of the myocardium and improved ventricular function have been demonstrated in patients with acute myocardial infarction (MI) treated by intracoronary delivery of autologous bone marrow mononuclear cells (BMC) a few days after successful myocardial reperfusion by percutaneous coronary intervention (PCI); however, the effects of intracoronary cell infusion in chronic MI patients are still unknown. AIMS: To investigate whether intracoronary infusion of BMC into the infarct-related artery in patients with healed MI could lead to improvement in left ventricular (LV) function. METHODS: Among 47 patients with stable ischaemic heart disease due to a previous MI (13 (SD 8) months previously), 24 were randomised to intracoronary infusion of BMC (BMC group) and 23 to a saline infusion (control group) into the target vessel after successful PCI within 12 hours after chest pain occurred. LV systolic and diastolic function, infarct size and myocardial perfusion defect were assessed with the use of echocardiography, magnetic resonance imaging (MRI) or (201)Tl single-photon-emission computed tomography (SPECT) at baseline and repeated at the 6-month follow-up examination. RESULTS: BMC treatment did not result in a significant increase in LV ejection fraction in any of the groups by any of the methods used, and the apparent tendency of an improvement was not statistically different between the two groups. The two groups also did not differ significantly in changes of LV end-diastolic and systolic volume, infarct size or myocardial perfusion. However, there was an overall effect of BMC transfer compared with the control group with respect to early/late (E/A) (p<0.001), early diastolic velocity/late diastolic (Aa) velocity (Ea/Aa) ratio (p = 0.002) and isovolumetric relaxation time (p = 0.038) after 6 months, as evaluated by tissue Doppler echocardiography. We noted no complications associated with BMS transfer. CONCLUSION: Intracoronary transfer of autologous BMC in patients with healed MI did not lead to significant improvement of cardiac systolic function, infarct size or myocardial perfusion, but did lead to improvement in diastolic function.

Li P, Guo ZG, Li Y, Xu DL. · Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. budaoweng_2000 @163.com · Nan Fang Yi Ke Da Xue Xue Bao. · Pubmed #18250038 links to  free full text

Abstract: OBJECTIVE: To study the plasma lipid level in patients with cardiovascular disease in Guangzhou and investigate its changes over the 10 years from 1995 to 2005. METHODS: According to the cluster sampling method, 1768 patients were selected for the study from the total patients admitted in the Department of Cardiology of Nanfang Hospital between 1995 and 2005. These patients were divided into 6 groups, namely uncomplicated hypertension group, coronary artery disease (CAD) or CAD risk equivalent group, CAD complicated by CAD risk equivalent group, hypertension complicated by CAD or CAD risk equivalent group, hypertension complicated by CAD and CAD risk equivalent group, and other cardiovascular disease group. The data of the plasma lipid levels in these patients were analyzed statistically. RESULTS: Significant changes occurred over the decade in the plasma lipid levels of these surveyed patients, and the TG, TC and HDL-C levels were significantly higher, but LDL-C levels significantly lower in patients surveyed in 2005 than in those surveyed in 1995. In 1995, the patients did not show gender-related difference in the plasma lipids, but till 2005, TG and HDL-C levels of the patients began to exhibit significant difference between genders. In 1995, patients with uncomplicated hypertension had the highest levels of TG, TC, and HDL-C among the patients of different cardiovascular conditions, but in 2005 this picture underwent obvious changes, and TG, TC, HDL-C, and LDL-C levels differed significantly between patients with various conditions. CONCLUSION: Plasma lipid levels of patients with cardiovascular diseases show significant changes over the 10 years with gender-related differences. In general, patients with uncomplicated hypertension have higher plasma lipid levels than those with other cardiovascular conditions.