Publications by authors named "Hongliang Cong"

62 Publications

Flow reserve fraction: the optimal choice in lesion assessing and interventional guiding for patient with unstable angina pectoris and intermediate lesion wrapped with myocardial bridge: a case report.

J Cardiothorac Surg 2021 Nov 21;16(1):336. Epub 2021 Nov 21.

Department of Cardiology, Tianjin Chest Hospital, Tianjin University, Chest Clinical Medical College of Tianjin Medical University, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.

Background: It is difficult to choose correctly interventional strategy for coronary intermediate lesions combined with myocardial bridge. Endovascular imaging is advocated to guide treatment, but flow reserve fraction (FFR) is not recommended to guide the interventional treatment of myocardial bridge disease because of the inaccurate judgment misled by myocardial bridge.

Case Presentation: In this study, we reported a case of a 56-year-old male patient with unstable angina pectoris (UAP). From his coronary angiography, we found diffuse stenosis near the midsection of the left anterior descending (LAD) branch and the presence of a severe myocardial bridge in the lesion area. We were sure that the LAD was culprit vessel and this lesion was culprit lesion. Both FFR and intravenous ultrasound (IVUS) were performed and the conclusions of them are different. Although stent implantation is not usually recommended in the myocardial bridge area. However, after careful examination, a stent was finally implanted under the precise guidance of FFR. And the patient recovered well up-to now.

Conclusions: This case illustrates that FFR functional test was complimentary to intravascular imaging test for the coronary intermediate lesion, especially the lesion wrapped with myocardial bridges, both in assessing the lesion and in guiding treatment.
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http://dx.doi.org/10.1186/s13019-021-01720-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607672PMC
November 2021

Syringaresinol attenuates sepsis-induced cardiac dysfunction by inhibiting inflammation and pyroptosis in mice.

Eur J Pharmacol 2021 Nov 19;913:174644. Epub 2021 Nov 19.

Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, 300222, China. Electronic address:

The mortality of sepsis-induced cardiac dysfunction (SICD) is very high due to the complex pathophysiological mechanism. Syringaresinol (SYR) is a natural abstract which possesses anti-inflammatory property. The present study aims was to identify the protective impact of SYR on sepsis-induced cardiac dysfunction and investigate the specific mechanisms. We found that SYR improved the cardiac function and alleviated myocardial injury in mice that subjected to cecal ligation and puncture, in addition, SIRT1 expression was significantly elevated after SYR treatment compared to sepsis group both in vivo and in vitro, along with suppression of NLRP3 activation and proinflammatory cytokines release. However, SIRT1 inhibitor EX427 abolished the impact of SYR on LPS-induced pyroptosis in cardiomyocytes. Furthermore, molecular docking analysis predicted that there is high affinity between SYR and estrogen receptor (ER), ER inhibitor ICI182780, the specific ERβ inhibitor PHTP and the specific ERαinhibitor AZD9496 were used to examine the role of ER in the protective effect of SYR against SICD, and the results suggested that ER activation was essential for the cardioprotective function of SYR. In conclusion, SYR ameliorates SICD via the ER/SIRT1/NLRP3/GSDMD pathway.
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http://dx.doi.org/10.1016/j.ejphar.2021.174644DOI Listing
November 2021

Comparison of Different Investigation Strategies to Defer Cardiac Testing in Patients With Stable Chest Pain.

JACC Cardiovasc Imaging 2021 Oct 7. Epub 2021 Oct 7.

Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China. Electronic address:

Objectives: This study aimed to compare the current 5 investigation strategies to defer cardiac testing in patients with stable chest pain.

Background: For the clinical management of stable chest pain, the identification of patients unlikely to benefit from further cardiac testing is important, but the most appropriate investigation strategy is unknown.

Methods: A total of 4,207 patients referred to coronary computed tomography angiography for stable chest pain were classified into low- and high-risk groups according to the 2016 National Institute of Health and Care Excellence (NICE) guideline-determined strategy; PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) minimal risk tool-based strategy; 2019 European Society of Cardiology (ESC) guideline-determined strategy; and coronary artery calcium score (CACS), either in isolation (the CACS strategy) or as part of a weighted clinical likelihood model-based strategy (the CACS-CL strategy). The associations of obstructive coronary artery disease on coronary computed tomography angiography, major adverse cardiovascular events, and subsequent clinical management with risk groups according to different strategies were evaluated and compared.

Results: The NICE, PROMISE, ESC, CACS, and CACS-CL strategies classified a proportion (22.63%, 29.21%, 41.84%, 46.76%, and 51.41%, respectively) of patients into low-risk groups. Compared with the NICE, PROMISE, ESC, and CACS strategies, the CACS-CL strategy had a stronger association between risk groups and obstructive coronary artery disease (odd ratios: 16.00 vs 2.93, 5.53, 7.94, and 10.39, respectively), major adverse cardiovascular events (HRs: 6.83 vs 1.90, 2.94, 4.23, and 5.13, respectively) and intensive subsequent clinical management as well as better metrics of diagnostic accuracy and positive net reclassification improvement.

Conclusions: Among contemporary strategies used to identify patients with stable chest pain at low risk, the use of CACS, especially when combined with clinical risk features, showed the strongest potential to effectively defer cardiac testing.
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http://dx.doi.org/10.1016/j.jcmg.2021.08.022DOI Listing
October 2021

Impact of persistent subclinical hypothyroidism on clinical outcomes in non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention.

Clin Endocrinol (Oxf) 2022 Jan 12;96(1):70-81. Epub 2021 Oct 12.

The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.

Background: Data on the association of subclinical hypothyroidism (SCH) with the severity of coronary artery disease and major adverse cardiovascular and cerebral events (MACCE) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) are limited and conflicting.

Objective: We established the baseline rate of SCH and followed the trajectory of thyroid-stimulating hormone (TSH) values during and after hospitalisation for PCI for up to six months and determined whether persistent SCH was associated with the severity of coronary artery disease and MACCE in patients with NSTE-ACS after PCI.

Design: Population-based prospective cohort study.

Patients: We included patients with NSTE-ACS who underwent PCI with simple balloon angioplasty or stent implantation for coronary heart disease.

Measurements: Thyroid function tests of patients before PCI and 1 day, 1 week, 1 and 6 months after PCI were performed. Cases showing transient SCH were excluded. Patients were divided into two groups based on the results of four TSH tests: 0.27-4.2 mIU/L (n = 1472, 89.7%) and >4.2 mIU/L (n = 170, 10.4%). The risk factors for the severity of coronary artery lesions were estimated using multinomial logistic regression analysis. Univariate and multivariate Cox regression analyses were used to study the relationship between TSH and MACCE.

Results: Among 1642 patients, there were 1070 males (65.2%) and 572 females (34.8%), with an average age of 62.5 ± 9.6 years. SCH patients had a wider range of diseased vessels and a higher number of diseased vessels (p < .05). TSH level was an independent risk factor for moderate [odds ratio (OR) = 1.144, 95% confidence interval (95% CI): 1.057-1.237, p = .001] and severe (OR = 1.131, 95% CI: 1.043-1.226, p = .003) coronary artery lesions. After adjusting for covariates, the risk of MACCE [hazard ratio (HR): 4.067, p < .001], nonfatal myocardial infarction (HR: 14.724, p = .003), and unplanned PCI (HR: 5.028, p < .001) were higher in the SCH group than in the euthyroidism group. There were no significant differences in the incidence of heart failure (HR: 6.012, p = .175), nonfatal stroke (HR: 2.039, p = .302), unplanned coronary artery bypass grafting (CABG) (HR: 1.541, p = .57), or cardiac death (HR: 2.704, p = .375) between the two groups.

Conclusions: Preoperative TSH levels and changes in thyroid hormone levels several months post-PCI in NSTE-ACS patients are highly significant in practice. Persistent SCH is associated with severe coronary artery lesions and MACCE, and may be a predictor for evaluating the prognosis of PCI-treated NSTE-ACS patients.
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http://dx.doi.org/10.1111/cen.14613DOI Listing
January 2022

The susceptibility of SERPINE1 rs1799889 SNP in diabetic vascular complications: a meta-analysis of fifty-one case-control studies.

BMC Endocr Disord 2021 Sep 30;21(1):195. Epub 2021 Sep 30.

Department of Cardiology, Tianjin Chest Hospital, Taierzhuang south Road No. 291, Jinnan District, 300350, Tianjin, China.

Background: The serine protease inhibitor-1 (SERPINE1) rs1799889 single nucleotide polymorphism (SNP) has been constantly associated with diabetes mellitus (DM) and its vascular complications. The aim of this meta-analysis was to evaluate this association with combined evidences.

Methods: The systematic search was performed for studies published up to March 2021 which assess the associations between SERPINE1 rs1799889 SNP and the risks of DM, diabetic retinopathy (DR), diabetic cardiovascular disease (CVD) and diabetic nephropathy (DN). Only case-control studies were identified, and the linkage between SERPINE1 rs1799889 polymorphism and diabetic vascular risks were evaluated using genetic models.

Results: 51 comparisons were enrolled. The results revealed a significant association with diabetes risk in overall population (allelic: OR = 1.34, 95 % CI = 1.14-1.57, homozygous: OR = 1.66, 95 % CI = 1.23-2.14, heterozygous: OR = 1.35, 95 % CI = 1.08-1.69, dominant: OR = 1.49, 95 % CI = 1.18-1.88, recessive: OR = 1.30, 95 % CI = 1.06-1.59) as well as in Asian descents (allelic: OR = 1.45, 95 % CI = 1.16-1.82, homozygous: OR = 1.88, 95 % CI = 1.29-2.75, heterozygous: OR = 1.47, 95 % CI = 1.08-2.00, dominant: OR = 1.64, 95 % CI = 1.21-2.24, recessive: OR = 1.46, 95 % CI = 1.09-1.96). A significant association was observed with DR risk (homozygous: OR = 1.25, 95 % CI = 1.01-1.56, recessive: OR = 1.20, 95 % CI = 1.01-1.43) for overall population, as for the European subgroup (homozygous: OR = 1.32, 95 % CI = 1.02-1.72, recessive: OR = 1.38, 95 % CI = 1.11-1.71). A significant association were shown with DN risk for overall population (allelic: OR = 1.48, 95 % CI = 1.15-1.90, homozygous: OR = 1.92, 95 % CI = 1.26-2.95, dominant: OR = 1.41, 95 % CI = 1.01-1.97, recessive: OR = 1.78, 95 % CI = 1.27-2.51) and for Asian subgroup (allelic: OR = 1.70, 95 % CI = 1.17-2.47, homozygous: OR = 2.46, 95 % CI = 1.30-4.66, recessive: OR = 2.24, 95 % CI = 1.40-3.59) after ethnicity stratification. No obvious association was implied with overall diabetic CVD risk in any genetic models, or after ethnicity stratification.

Conclusions: SERPINE1 rs1799889 4G polymorphism may outstand for serving as a genetic synergistic factor in overall DM and DN populations, positively for individuals with Asian descent. The association of SERPINE1 rs1799889 SNP and DR or diabetic CVD risks was not revealed.
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http://dx.doi.org/10.1186/s12902-021-00837-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482645PMC
September 2021

The efficacy and safety of quantitative flow ratio-guided complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: A pilot randomized controlled trial.

Cardiol J 2021 Sep 28. Epub 2021 Sep 28.

Department of Cardiology, Thoracic Clinical College, Tianjin Medical University, Tai'erzhuang Road, No.261, Jinnan District, Tianjin, 300222 Tianjin, China.

Background: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), the treatment strategy for non-infarct-related artery (non-IRA) remains controversial. Quantitative flow ratio (QFR) is a new angiography-based physiological assessment index. However, there is little evidence on the practical clinical application of QFR.

Methods: Two hundred and twenty-nine patients with STEMI and MVD were recruited for this study. Patients were randomly assigned to either receive QFR-guided complete revascularization (QFR-G-CR) of non-IRA or receive no further invasive treatment. The primary (1º) endpoint analyzed included death due to all causes, non-fatal myocardial infarction (MI), and ischemia-induced revascularization at 12 months post-surgery. Secondary (2º) endpoints included cardiovascular death, unstable angina, stent thrombosis, New York Heart Association (NYHA) class IV heart failure (HF), and stroke at 1 year post surgery. Massive bleeding and contrast-associated acute kidney injury (CAKI) were used as safety endpoints.

Results: Around the 12 month follow up, the 1º outcome was recorded in 11/115 patients (9.6%) in the QFR-G-CR population, relative to 23/114 patients (20.1%) in the IRA-only PCI population (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.22-0.92; p = 0.025). Unstable angina in 6 (5.2%) and 16 (14.0%) patients (HR: 0.36; 95% CI: 0.14-0.92; p = 0.026), respectively. No marked alterations were found in the massive bleeding and CAKI categories.

Conclusions: In conclusion, STEMI and MVD patients can benefit from QFR-G-CR of non-IRA lesions in the initial stages of acute MI. This can help reduce incidences of major adverse cardiovascular events and unstable angina, relative to IRA treatment only. Chinese Clinical Trial Registration number: ChiCTR2100044120.
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http://dx.doi.org/10.5603/CJ.a2021.0111DOI Listing
September 2021

Blood pressure visit-to-visit variability and outcomes in patients with heart failure with preserved ejection fraction.

ESC Heart Fail 2021 10 18;8(5):3984-3996. Epub 2021 Aug 18.

Department of Cardiology, Tianjin Chest Hospital, #261 Taierzhuangnan Road, Jinnan District, Tianjin, China.

Aims: Previous studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fraction (HFpEF). This study sought to explore the association between visit-to-visit variability (VVV) of BP and clinical outcomes in patients with HFpEF.

Methods And Results: A total of 1988 patients (mean age of 67.73 ± 9.22, 51.7% female) from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this study. BP-VVV was determined by standard deviation (SD) of mean systolic BP (SBP-SD) from six measurements (baseline and months 1, 2, 4, 8, and 12) during the first 12 months after randomization. Mean on-treatment SBP during the first 12 months was 127.77 ± 10.42 mmHg, and the median of SBP-SD was 8.15 mmHg. A total of 192 (9.7%) patients met the primary outcome during the subsequent median follow-up of 35.16 months, including a composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Multiple Cox regression analysis showed that SBP-SD was independently associated with the increased risk of the primary outcome after adjusting for age, gender, method of BP measurement, treatment, renal function and common co-morbidities, and the mean SBP during the first 12 months [hazard ratio (HR) for fourth vs. first quartile, 1.63; 95% confidence interval (CI), 1.07-2.49; P = 0.024]. Analysis showed that SBP-SD as continuous variable was associated with a 23% increase in the risk of primary outcome (HR 1.23, 95% CI 1.06-1.43; P = 0.006).

Conclusions: The findings of the current study show that high SBP-VVV in patients with HFpEF is associated with an increased risk of adverse outcomes independent of the mean on-treatment SBP.
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http://dx.doi.org/10.1002/ehf2.13542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497211PMC
October 2021

Predictive Value of the Triglyceride to High-Density Lipoprotein Cholesterol Ratio for All-Cause Mortality and Cardiovascular Death in Diabetic Patients With Coronary Artery Disease Treated With Statins.

Front Cardiovasc Med 2021 21;8:718604. Epub 2021 Jul 21.

Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.

Studies have highlighted the role of the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio on subsequent cardiovascular events. However, the association of the TG/HDL-C ratio with survival outcomes in diabetic patients with coronary artery disease (CAD) treated with statins remains unknown. This study aimed to assess the predictive value of the TG/HDL-C ratio for all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins. The data of patients with type 2 diabetes and angiographically-confirmed CAD who were undergoing statin therapy and visited Tianjin Chest Hospital between January 2016 and September 2016 were retrospectively collected. The patients were categorized based on the baseline TG/HDL-C ratio tertile. Kaplan-Meier analysis and multivariate Cox proportional hazard regression were applied to assess the role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death. A total of 2,080 patients were included. During the 4-year follow-up, 209 patients died, 136 of whom from cardiovascular death. The Kaplan-Meier analyses showed that an increased TG/HDL-C ratio was associated with an increased risk of all-cause mortality ( < 0.001) and cardiovascular death ( < 0.001). The multivariate cox hazard regression analysis revealed a similar effect of the TG/HDL-C ratio on the risk of all-cause mortality ( = 0.046) and cardiovascular death ( = 0.009). The role of the TG/HDL-C ratio in predicting all-cause mortality and cardiovascular death was similar among all subgroups ( > 0.050). For all-cause mortality, the TG/HDL-C ratio significantly improved the C-statistic from 0.799 to 0.812 ( = 0.018), and the net reclassification index (NRI) and integrated discrimination index (IDI) were 0.252 (95% CI: 0.112-0.392; < 0.001) and 0.012 (95% CI: 0.003-0.022; = 0.012), respectively. Similarly, for cardiovascular death, the TG/HDL-C ratio significantly improved the C-statistic from 0.771 to 0.804 ( < 0.001), and the NRI and IDI were 0.508 (95% CI: 0.335-0.680; < 0.001) and 0.033 (95% CI: 0.015-0.050; < 0.001). TG/HDL-C ratio might be useful for predicting all-cause mortality and cardiovascular death in diabetic patients with CAD treated with statins.
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http://dx.doi.org/10.3389/fcvm.2021.718604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8333610PMC
July 2021

Correlation Between the Triglyceride-Glucose Index and High Risk of Cardiovascular Disease: A Cohort Study of 102,061 Subjects from Tianjin, China.

Risk Manag Healthc Policy 2021 2;14:2803-2810. Epub 2021 Jul 2.

Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, 300222, People's Republic of China.

Objective: This study aims to investigate the correlation between triglyceride-glucose index (TyG) and the risk of cardiovascular disease (CVD).

Methods: A total of 102,061 permanent residents of Tianjin, China, aged 35-75 years were surveyed. A questionnaire, physical examination, and blood tests for biochemical markers were conducted for all subjects. The risk of CVD was judged based on the results, identifying the population with a high risk of CVD. TyG was calculated for all subjects who were then grouped into TyG quartiles. The correlation between TyG and the detection rate of subjects with a high risk of CVD was analyzed using the chi-square test and Pearson's correlation analysis. The cut-off points and the magnitude of the predictive effect of TyG in determining a high risk of CVD were identified by calculating the TyG through analysis of the receiver operator characteristic (ROC) curve.

Results: The surveyed population consisted of 39,598 males (38.8%) and 62,463 females (61.2%). The average age was 55.84 ± 10.27 years. A statistically significant difference in the incidence of a high CVD risk between subjects in the four groups divided by the TyG levels was identified ( < 0.01). Pearson's correlation analysis showed that TyG was correlated with all risk factors for CVD ( < 0.01). The maximum Youden's J statistic for determining the high risk of CVD was found at a TyG of 9.04 (specificity 0.575, sensitivity 0.754). The area under the ROC curve was 0.780 (confidence interval [CI]: 0.777, 0.783, < 0.01).

Conclusion: TyG index is closely related to the aggregation of cardiovascular risk factors and is correlated with the judgment results of the screening population's high risk of CVD, suggesting that more attention should be paid to the identification and control of multiple risk factors in the population with significantly elevated TyG.
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http://dx.doi.org/10.2147/RMHP.S316484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260047PMC
July 2021

Loss of TRIM21 alleviates cardiotoxicity by suppressing ferroptosis induced by the chemotherapeutic agent doxorubicin.

EBioMedicine 2021 Jul 4;69:103456. Epub 2021 Jul 4.

Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. Electronic address:

Background: Doxorubicin, an anthracycline chemotherapeutic agent, is widely used in the treatment of many cancers. However, doxorubicin posts a great risk of adverse cardiovascular events, which are thought to be caused by oxidative stress. We recently reported that the ubiquitin E3 ligase TRIM21 interacts and ubiquitylates p62 and negatively regulates the p62-Keap1-Nrf2 antioxidant pathway. Therefore, we sought to determine the role TRIM21 in cardiotoxicity induced by oxidative damage.

Methods: Using TRIM21 knockout mice, we examined the effects of TRIM21 on cardiotoxicity induced by two oxidative damage models: the doxorubicin treatment model and the Left Anterior Descending (LAD) model. We also explored the underlying mechanism by RNA-sequencing of the heart tissues, and by treating the mouse embryonic fibroblasts (MEFs), immortalized rat cardiomyocyte line H9c2, and immortalized human cardiomyocyte line AC16 with doxorubicin.

Findings: TRIM21 knockout mice are protected from heart failure and fatality in both the doxorubicin and LAD models. Hearts of doxorubicin-treated wild-type mice exhibit deformed mitochondria and elevated level of lipid peroxidation reminiscent of ferroptosis, which is alleviated in TRIM21 knockout hearts. Mechanistically, TRIM21-deficient heart tissues and cultured MEFs and H9c2 cells display enhanced p62 sequestration of Keap1 and are protected from doxorubicin-induced ferroptosis. Reconstitution of wild-type but not the E3 ligase-dead and the p62 binding-deficient TRIM21 mutants impedes the protection from doxorubicin-induced cell death.

Interpretation: Our study demonstrates that TRIM21 ablation protects doxorubicin-induced cardiotoxicity and illustrates a new function of TRIM21 in ferroptosis, and suggests TRIM21 as a therapeutic target for reducing chemotherapy-related cardiotoxicity.

Funding: NIH (CA129536; DK108989): data collection, analysis. Shanghai Pujiang Program (19PJ1401900): data collection. National Natural Science Foundation (31971161): data collection. Department of Veteran Affairs (BX004083): data collection. Tianjin Science and Technology Plan Project (17ZXMFSY00020): data collection.
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http://dx.doi.org/10.1016/j.ebiom.2021.103456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261003PMC
July 2021

The association of triglyceride and glucose index, and triglyceride to high-density lipoprotein cholesterol ratio with prehypertension and hypertension in normoglycemic subjects: A large cross-sectional population study.

J Clin Hypertens (Greenwich) 2021 07 12;23(7):1405-1412. Epub 2021 Jun 12.

Tianjin Chest Hospital, Tianjin, China.

Insulin resistance (IR) plays an important role in the development of hypertension. Triglyceride and glucose index (TyG index), and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c) as effective IR surrogate indexes have been verified in numerous studies. Therefore, the authors conducted a large cross-sectional study to explore the association of TyG index and TG/HDL-c with prehypertension and hypertension in the same normoglycemic subjects from Tianjin, China. A total of 32 124 adults were eligible for this study. According to the level of blood pressure, the enrolled individuals were divided into three groups, which were normotension, prehypertension, and hypertension. In multiple logistic regression analysis, there was associated with prehypertension and hypertension when comparing the highest TyG index to the lowest TyG index and corresponding ORs were 1.795 (1.638, 1.968) and 2.439 (2.205, 2.698), respectively. For TG/HDL-c, the corresponding ORs were 1.514 (1.382, 1.658) and 1.934 (1.751, 2.137), respectively. Furthermore, when comparing the fourth quartile to the first quartile of TyG index and TG/HDL-c, respectively, both corresponding ORs of hypertension were higher than prehypertension. Elevated TyG index and TG/HDL-c levels were associated with prehypertension and hypertension in normoglycemic individuals. Moreover, the TyG index was more significant than TG/HDL-c in distinguishing hypertension. They have the potential to become cost-effective monitors in the hierarchical management of prehypertension and hypertension.
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http://dx.doi.org/10.1111/jch.14305DOI Listing
July 2021

Corrigendum to "Comparison of the CAMI-NSTEMI and GRACE Risk Model for Predicting In-Hospital Mortality in Chinese Non-ST-Segment Elevation Myocardial Infarction Patients".

Cardiol Res Pract 2021 10;2021:5137403. Epub 2021 Feb 10.

Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.

[This corrects the article DOI: 10.1155/2020/2469281.].
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http://dx.doi.org/10.1155/2021/5137403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896849PMC
February 2021

A nomogram for predicting the risk of no-reflow after primary percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial infarction.

Ann Transl Med 2021 Jan;9(2):126

Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.

Background: The purpose of this study was to screen the predictive factors of no-reflow after a percutaneous coronary intervention (PCI) in elderly patients with ST-segment elevation myocardial infarction (STEMI), and to construct a nomogram model, to guide clinical treatment.

Methods: A total of 551 elderly STEMI patients (age >65) underwent direct PCI were randomly classified into training group (n=386, 70%) and validation group (n=165, 30%). All patients in the two groups were divided into a no-reflow group and a normal blood flow group according to whether there was a no-reflow phenomenon. Univariable and multivariable logistic regression analysis was used to analyze the relevant data, including demographic characteristics, clinical characteristics, coronary angiography results, electrocardiogram (ECG) results, and biochemical indicators. Then, a nomogram model was constructed on the screened risk factors. The performance of the nomogram was evaluated in terms of discrimination and calibration. The nomogram was further confirmed in the internal validation group. Additionally, decision curve analysis (DCA) was applied to assess the clinical usefulness of the nomogram.

Results: Five remarkable risk factors were determined: preoperative TIMI blood flow, the diameter of the target lesion, collateral circulation, pulse pressure, and the number of leads for ST-segment elevation. The nomogram involving these five risk factors showed full calibration and discrimination in the training group, with an AUC of 0.71 (95% CI: 0.66-0.77). It was confirmed in the validation group, and the entire cohort and the AUC were 0.64 (95% CI: 0.56-0.73) and 0.69 (95% CI: 0.65-0.74), respectively. Whether in the training group or the verification group, the calibration curve for the probability of no-reflow phenomenon all showed considerable consistency between prediction by nomogram and actual observation. The decision curve revealed a specific role in our nomogram in clinical practice.

Conclusions: We set up a nomogram that showed absolute accuracy for the prediction of the risk of no-reflow after primary PCI in elderly STEMI patients.
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http://dx.doi.org/10.21037/atm-20-8003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867879PMC
January 2021

Effect of ABCA1 promoter methylation on premature coronary artery disease and its relationship with inflammation.

BMC Cardiovasc Disord 2021 02 8;21(1):78. Epub 2021 Feb 8.

Department of Military General Medicine, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China.

Background: ATP-binding cassette transporter A1 (ABCA1) plays a major role in high-density lipoprotein (HDL) metabolism and reverse cholesterol transport (RCT) and exerts anti-inflammatory effects. Increased ABCA1 promoter methylation level may result in the progression of coronary artery disease. Thus, the present study investigated the association between promoter methylation status of ABCA1 and inflammation in the development of premature coronary artery disease (pCAD).

Methods: PCAD patients and healthy individuals (n = 90 each) were recruited from the Characteristic Medical Center of the Chinese People's Armed Police Force from June to December 2019. Using pyrosequencing, the levels of ABCA1 promoter methylation in their blood samples were evaluated. Serum concentrations of lipids, interleukin 1β (IL-1β), C-reactive protein (CRP), and circulating free DNA/Neutrophil extracellular traps (cfDNA/NETs) were also routinely measured and compared between the two groups. P values < 0.05 were considered statistically significant.

Results: The mean ABCA1 promoter methylation levels were significantly higher in the pCAD group than in the control group (44.24% ± 3.66 vs. 36.05% ± 2.99, P < 0.001). Based on binary logistic regression analysis, ABCA1 promoter methylation level was identified as an independent risk factor for pCAD development (odds ratio = 2.878, 95% confidence interval: 1.802-4.594, P < 0.001). Furthermore, ABCA1 promoter methylation levels were negatively correlated with HDL levels (r =  - 0.488, P < 0.001) and positively correlated with the levels of CRP, cfDNA/NETs, and IL-1β (r = 0.389, 0.404, 0.385, respectively; P < 0.001). Multiple regression analysis showed that the serum levels of CRP, IL-1β, and cfDNA/NETs independently affect ABCA1 promoter methylation.

Conclusions: Our findings indicate that high methylation levels at the ABCA1 promoter are associated with low HDL cholesterol levels and an increased risk of pCAD. Inflammatory factors and NETs may be involved in the progression of pCAD by affecting ABCA1 promoter methylation levels.
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http://dx.doi.org/10.1186/s12872-021-01894-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869242PMC
February 2021

Distribution of risk factors of hypertension patients in different age groups in Tianjin.

BMC Public Health 2021 01 29;21(1):247. Epub 2021 Jan 29.

Department of Cardiology, Tianjin Chest Hospital, No. 261 of Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.

Background: To analyze the risk factors for hypertension in different age groups of urban and rural residents in Tianjin.

Methods: A total of 33,997 people (35-75 years old) from 13 community health service centers and primary hospitals in Tianjin participated in this study. They were divided into the youth group (≤ 40 years old), middle-aged group (41-65 years old), and elderly group (> 65 years old). Then, a questionnaire survey was administered, followed by physical and blood biochemical examinations. The demographic characteristics and prevalence were recorded and counted. Subsequently, risk factors were analyzed using univariate and stepwise multivariate logistic regression analysis.

Results: In the youth, middle-aged, and elderly groups, the prevalence rate of hypertension was 18.65, 51.80, and 76.61%, respectively. Logistic regression analysis showed that obesity(OR: 3.263, 95% CI: 1.039-1.656), men (OR: 2.117, 95% CI: 1.691-2.651), diabetes (OR: 1.978, 95% CI: 1.398-2.799), high triglycerides(OR 1.968 95% CI: 1.590-2.434) and family history of stroke (OR: 1.936, 95% CI: 1.287-2.911) are the five factors in youth. In middle-aged group, the significantly associating factors were obesity (OR: 2.478, 95% CI: 2.330-2.636), diabetes (OR: 2.173, 95% CI: 1.398-2.799), family history of stroke (OR: 1.808, 95% CI: 1.619-2.020), maleness (OR: 1.507, 95% CI: 1.412-1.609),Hypertriglyceridemia (OR 1.490 95% CI: 1.409-1.577),family history of cardiovascular disease (OR: 1.484, 95% CI: 1.307-1.684),Hypercholesterolemia (OR 1.228 95% CI: 1.160-1.299). In the elderly group, obesity (OR: 2.104, 95% CI: 1.830-2.418), family history of strokes (OR: 1.688, 95% CI: 1.243-2.292), diabetes mellitus (OR: 1.544, 95% CI: 1.345-1.773), family history of cardiovascular disease (OR: 1.470, 95% CI: 1.061-2.036), hypertriglyceridemia (OR: 1.348, 95% CI: 1.192-1.524) increased the risk for hypertension. Waist circumference (WC) and waist-to-height ratio (WHtR) increased with age, and the value of these two measures for predicting hypertension was better than BMI in middle-aged group.

Conclusion: Obesity is the most important risk factor for hypertension in all age groups. Diabetes, family history of strokes and high triglyceride were also significant risk factors for all age groups. There was a gender difference between the young and middle-aged groups, with men more likely to hypertension. Waist circumference (WC) and waist-to-height ratio (WHtR) were better predictors of hypertension than BMI in middle-aged group.
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http://dx.doi.org/10.1186/s12889-021-10250-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846994PMC
January 2021

Effect of PCSK9 inhibitor on lipoprotein particles in patients with acute coronary syndromes.

BMC Cardiovasc Disord 2021 01 7;21(1):19. Epub 2021 Jan 7.

Department of Cardiology, Tianjin Chest Hospital, No. 261 Taierzhuang South Road, Jinnan District, Tianjin, China.

Background: To assess the effects of proprotein convertase subtilisin/kexin type 9 inhibitor (evolocumab) on lipoprotein particles subfractions with Nuclear Magnetic Resonance spectroscopy in patients with acute coronary syndromes.

Methods: A total of 99 consecutive patients with ACS were enrolled and assigned to either the experimental group (n = 54) or the control group (n = 45). The combination therapy of PCSK9 inhibitor (Repatha®, 140 mg, q2w) and moderate statin (Rosuvastatin, 10 mg, qn) was administered in the experimental group, with statin monotherapy (Rosuvastatin, 10 mg, qn) in the control group. The therapeutic effects on lipoprotein particle subfractions were assessed with NMR spectroscopy after 8 weeks treatment, and the achievement of LDL-C therapeutic target in both groups were analyzed.

Results: In the experimental group, after 8 weeks of evolocumab combination treatment, the concentrations of blood lipids (TC, LDL-C and its subfractions [LDL-1 to 6], VLDL-C and its subfractions [VLDL-1 to 5], IDL-C, and HDL-C), lipoprotein particles, and their subfractions [VLDL-P, IDL-P, LDL-P, and its subfractions [LDL-P1 to 6], apoB, and LP(a)] demonstrated therapeutic benefits with statistical significance (P < 0.05). The decrease in total LDL-P concentrations was mainly due to a decreased concentration of small-sized LDL particles (LDL-P 5 + 6), which was significantly more prominent than the decrease in medium-sized LDL-P (LDL-P3 + 4) and large-sized LDL-P (LDL-P1 + 2) (P < 0.001). According to lipid control target recommended by the latest China Cholesterol Education Program Expert Consensus in 2019, after 8 weeks treatment, 96.3% patients in the experimental group and 13.3% in the control group had achieved the LDL-C therapeutic target (P < 0.01).

Conclusions: Evolocumab combination treatment for 8 weeks significantly improves the plasma lipid profiles in ACS patients, and significantly decrease the concentration of lipoprotein particles which might contribute to the pathonesis of atherosclerosis.
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http://dx.doi.org/10.1186/s12872-020-01827-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789487PMC
January 2021

Correlations between lipoprotein(a) gene polymorphisms and calcific aortic valve disease and coronary heart disease in Han Chinese.

J Int Med Res 2020 Oct;48(10):300060520965353

Department of Clinical Laboratory, Tianjin Chest Hospital, Tianjin, China.

Objective: To investigate the relationship between lipoprotein(a) gene () polymorphisms and calcific aortic valve disease (CAVD) and coronary heart disease (CHD) in Han Chinese.

Methods: A total of 148 patients were recruited (n = 71 with CAVD and n = 77 with CHD) based on a diagnosis achieved using color Doppler echocardiography, coronary angiography, or computed tomography angiography. Seventy-one control individuals without CAVD or CHD were also recruited. Biomarkers including levels of lipoprotein(a) [Lp(a)], low-density lipoprotein and high-density lipoprotein cholesterol, apolipoprotein A1, and apolipoprotein B were tested. polymorphisms rs10455872, rs6415084, rs3798221, and rs7770628 were analyzed using SNaPshot SNP.

Results: Lp(a) levels were significantly higher in CAVD and CHD groups compared with controls. There was no significant difference in the allelic frequency distribution of rs3798221, rs7770628, or rs6415084 between CHD, CAVD, and control groups. Linear regression showed that rs3798221, rs7770628, and rs6415084 were associated with increased Lp(a) concentrations. Two CAVD patients among the 219 participants carried AG minor alleles at rs10455872, while the remainder carried AA minor alleles.

Conclusion: rs3798221, rs6415084, and rs7770628 polymorphisms within are associated with higher Lp(a) plasma levels, which correlate with increased CAVD and CHD risks.
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http://dx.doi.org/10.1177/0300060520965353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645393PMC
October 2020

Value of Blood-Based microRNAs in the Diagnosis of Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.

Front Physiol 2020 14;11:691. Epub 2020 Aug 14.

School of Medicine, NanKai University, Tianjin, China.

Recent studies have shown that blood-based miRNAs are dysregulated in patients with acute myocardial infarction (AMI) and are therefore a potential tool for the diagnosis of AMI. Therefore, this study summarized and evaluated studies focused on microRNAs as novel biomarkers for the diagnosis of AMI from the last ten years. MEDLINE, the Cochrane Central database, and EMBASE were searched between January 2010 and December 2019. Studies that assessed the diagnostic accuracy of circulating microRNAs in AMI were chosen. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC) were used to assess the test performance of miRNAs. A total of 58 studies that included 8,206 participants assessed the diagnostic accuracy of circulating miRNAs in AMI. The main results of the meta-analyses are as follows: (1) Total miRNAs: the overall pooled sensitivity and specificity were 0.82 (95% CI: 0.79-0.85) and 0.87 (95% CI: 0.84-0.90), respectively. The AUC value was 0.91 (95% CI: 0.88-0.93) in the overall summary receiver operator characteristic (SROC) curve. (2) The panel of two miRNAs: sensitivity: 0.88 (95% CI: 0.77-0.94), specificity: 0.84 (95% CI: 0.72-0.91), AUC: 0.92 (95% CI: 0.90-0.94). (3) The panel of three miRNAs: sensitivity: 0.91 (95% CI: 0.85-0.94), specificity: 0.87 (95% CI: 0.77-0.92), AUC: 0.92 (95% CI: 0.89-0.94). (4) Results by types of miRNAs: miRNA-1: sensitivity: 0.78 (95% CI: 0.71-0.84), specificity: 0.86 (95% CI: 0.77-0.91), AUC: 0.88 (95% CI: 0.85-0.90); miRNA-133a: sensitivity: 0.85 (95% CI: 0.69-0.94), specificity: 0.92 (95% CI: 0.61-0.99), AUC: 0.93 (95% CI: 0.91-0.95); miRNA-208b: sensitivity: 0.80 (95% CI: 0.69-0.88), specificity: 0.96 (95% CI: 0.77-0.99), AUC: 0.91 (95% CI: 0.88-0.93); miRNA-499: sensitivity: 0.85 (95% CI: 0.77-0.91), specificity: 0.95 (95% CI: 0.89-0.98), AUC: 0.96 (95% CI: 0.94-0.97). miRNAs may be used as potential biomarkers for the detection of AMI. For single, stand-alone miRNAs, miRNA-499 may have better diagnostic accuracy compared to other miRNAs. We propose that a panel of multiple miRNAs with high sensitivity and specificity should be tested.
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http://dx.doi.org/10.3389/fphys.2020.00691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456928PMC
August 2020

An Analysis of Medication Prescriptions for Hypertension in Urban and Rural Residents in Tianjin.

Adv Ther 2020 10 28;37(10):4414-4426. Epub 2020 Aug 28.

Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, China.

Introduction: This study aims to examine the medication prescriptions for hypertension in Tianjin.

Methods: Patients with hypertension in Tianjin were enrolled in this study. The patients' ages ranged from 35 to 75 years. A questionnaire survey and physical examination were completed to collect clinical data. Thereafter, a statistical analysis of the medication prescriptions was conducted with different age groups and different grades of hypertension.

Results: The results show that, in the total population, and for the young, middle-aged, and older groups, the proportions of single-drug use were 62.97%, 59.26%, 62.76%, and 63.49%, respectively, and the highest rate was for calcium channel blocker (CCB) use. The rates of the two drug classes were 24.51%, 29.63%, 25.13%, and 23.15%, respectively. The drug use rate of CCBs combined with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARBs) was the highest. The rates of the three drug classes were 4.08%, 4.94%, 4.36%, and 3.52%, respectively, and the highest was ACEI/ARB and CCB combined with diuretics. The rates of the four drug classes were low. Regarding the hypertension grade, in grade 1, grade 2, and grade 3, the rates of single-drug use were 63.53%, 62.69%, and 58.38%, respectively. The rates of the two drug classes were 24.62%, 23.97%, and 25.05%, while the rates of the three drug classes were 3.86%, 4.39%, and 5.34%, respectively.

Conclusion: The rate of single-drug use was high, and the rate of combined drug use in the youth group was slightly higher than in the middle-aged and older age groups. The combination of two drugs was common. In grades 2 and 3 hypertension, the rate of combined drug use remained low.
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http://dx.doi.org/10.1007/s12325-020-01475-yDOI Listing
October 2020

Comparison of the CAMI-NSTEMI and GRACE Risk Model for Predicting In-Hospital Mortality in Chinese Non-ST-Segment Elevation Myocardial Infarction Patients.

Cardiol Res Pract 2020 24;2020:2469281. Epub 2020 Jul 24.

Tianjin Medical University, Tianjin, China.

Introduction: The ability of risk models to predict in-hospital mortality and the influence on downstream therapeutic strategy has not been fully investigated in Chinese Non-ST-segment elevation myocardial infarction (NSTEMI) patients. Thus, we sought to validate and compare the performance of the Global Registry of Acute Coronary Events risk model (GRM) and China Acute Myocardial Infarction risk model (CRM) and investigate impacts of the two models on the selection of downstream therapeutic strategies among these patients.

Methods: We identified 2587 consecutive patients with NSTEMI. The primary endpoint was in-hospital death. For each patient, the predicted mortality was calculated according to GRM and CRM, respectively. The area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow (H-L) test, and net reclassification improvement (NRI) were used to assess the performance of models.

Results: In-hospital death occurred in 4.89% (126/2587) patients. Compared to GRM, CRM demonstrated a larger AUC (0.809 versus 0.752, < 0.0001), less discrepancy between observed and predicted mortality (H-L : 22.71 for GRM, =0.0038 and 10.25 for CRM, =0.2479), and positive NRI (0.3311, < 0.0001), resulting in a significant change of downstream therapeutic strategy.

Conclusion: In Chinese NSTEMI patients, the CRM provided a more accurate estimation for in-hospital mortality, and application of the CRM instead of the GRM changes the downstream therapeutic strategy remarkably.
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http://dx.doi.org/10.1155/2020/2469281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396005PMC
July 2020

Effects of miR-124-3p regulation of the p38MAPK signaling pathway via MEKK3 on apoptosis and proliferation of macrophages in mice with coronary atherosclerosis.

Adv Clin Exp Med 2020 Jul;29(7):803-812

Department of Cardiology, Tianjin Chest Hospital, China.

Background: Atherosclerosis (AS) is the main cause of myocardial infarction and stroke. Macrophage apoptosis in the early stages can attenuate lesions, while in the late stage it is associated with AS plaque rupture.

Objectives: To explore the effects of miR-124-3p regulation of the p38MAPK signaling pathway via the MEKK3 gene on the apoptosis and proliferation of macrophages in mice with coronary AS.

Material And Methods: Fifty male apolipoprotein E (ApoE) -/- mice were equally assigned to a normal group and a coronary AS group. In the AS group, the mice were given a high-fat diet to establish a coronary AS model. The macrophages of the mice were isolated for culture and divided into 7 groups: normal, negative control (NC), control, miR-124-3p mimic, miR-124-3p inhibitor, si-MEKK3, and miR-124-3p inhibitor+si-MEKK3.

Results: Compared with the normal group, the AS group had lower expression levels of miR-124-3p and higher expression levels of MEKK3 and p-p38MAPK in the coronary artery tissue and peritoneal macrophages (all p < 0.050). We found that miR-124-3p could negatively regulate MEKK3 expression. Compared with the control group, the miR-124-3p mimic group and si-MEKK3 group had greater cell apoptosis rates and Bax levels, weaker cell proliferation and invasion abilities, slower cell cycle progression, and lower PCNA and Bcl-2 levels (all p < 0.050). This trend was also displayed in the miR-124-3p inhibitor+si-MEKK3 group when compared with the miR-124-3p inhibitor group, and in the si-MEKK3 group when compared with the miR-124-3p inhibitor+si-MEKK3 group (all p < 0.050).

Conclusions: miR-124-3p overexpression can downregulate MEKK3 expression and inhibit the expression of the p38MAPK signaling pathway, thereby inhibiting macrophage proliferation and promoting macrophage apoptosis in mice with coronary AS.
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http://dx.doi.org/10.17219/acem/121926DOI Listing
July 2020

Prediction of no-reflow phenomenon in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Medicine (Baltimore) 2020 Jun;99(26):e20152

Department of Cardiology, Tianjin Chest Hospital.

No-reflow is an important complication among patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).A retrospective study of 1658 STEMI patients undergoing direct PCI was performed. Patients were randomly assigned at a 7:3 ratio into development cohort and validation cohort and into no-reflow and normal blood flow groups. Clinical data and laboratory examinations were compared to identify independent risk factors and establish a no-reflow risk scoring system.In the development cohort (n = 1122), 331 (29.5%) had no-reflow. Multivariate analysis showed age ≥ 65 years (OR = 1.766, 95% confidence interval (CI): 1.313-2.376, P < .001), not using angiotonase inhibitor/angiotensin receptor antagonists (OR = 1.454, 95%CI: 1.084-1.951, P = .013), collateral circulation 8 mmol/L (OR = 1.386, 95%CI: 1.007-1.908, P = .045) were related to no-reflow. Receiver operating characteristic (ROC) area under the curve was 0.648 (95%CI: 0.609-0.86). At 0.349 cutoff sensitivity was 42.0%, specificity was 79.3%, positive predictive value (PPV) was 44.7%, negative predictive value (NPV) was 77.4%, P < .001. The resulting risk scoring system was tested in the validation cohort (n = 536), with 30.1% incidence of no-reflow. The area under the ROC curve was 0.637 (95%CI: 0.582-0.692). At a cutoff of 0.349 sensitivity was 53.2% and specificity was 66.7%, PPV was 41.2%, NPV was 76.4%, P < .001.The no-reflow risk scoring system was effective in identifying high-risk patients.
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http://dx.doi.org/10.1097/MD.0000000000020152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329019PMC
June 2020

Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis.

J Int Med Res 2020 Jun;48(6):300060520926349

School of Medicine, Nankai University, Tianjin, China.

Objective: Statins have been shown to be beneficial for the prevention of cardiovascular events. In elderly individuals, the efficacy of statins remains controversial and the comparative effect of statins has not been assessed.

Methods: MEDLINE, Embase, and the Cochrane Central database were searched for randomized controlled trials that assessed statins in older patients.

Results: Seventeen trials were analyzed. When used for secondary prevention, statins were associated with reduced risk of cardiovascular events, all-cause mortality, cardiovascular mortality, revascularization, and stroke. When used for primary prevention, statins reduced the risk of myocardial infarction and revascularization, but did not significantly affect other outcomes. A modest difference between pharmaceutical statin products was found, and high-quality evidence indicated that intensive atorvastatin had the greatest benefits for secondary prevention.

Conclusions: In secondary prevention, evidence strongly suggests that statins are associated with a reduction in the risk of all-cause mortality, cardiovascular events, cardiovascular mortality, and revascularization. However, differences in the effects of various statins do not appear to have significant effects on therapy in secondary prevention for the elderly.
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http://dx.doi.org/10.1177/0300060520926349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294495PMC
June 2020

Risk factors for cardiovascular disease from a population-based screening study in Tianjin, China: a cohort study of 36,215 residents.

Ann Transl Med 2020 Apr;8(7):444

Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300222, China.

Background: Cardiovascular disease (CVD) is a harmful disease that poses a serious threat to human life. By effectively controlling its risk factors, the occurrence and development of CVD can be reduced, and people's health status and quality of life can be improved.

Methods: A total of 36,215 participants were collected from participants of the Early Screening and Comprehensive Intervention Program for High Risk Population of Cardiovascular Disease in Tianjin on July 31, 2017. We analyzed the relationship between CVD risk and personal information, personal and family medical history, biochemical index, and physical fitness index using Pearson's chi-squared test with and without Yates's correction for continuity, and Fisher's exact test. CVD risk-related factors were examined through logistic regression and decision tree analysis.

Results: A personal history of hypertension and apoplexy had a contingency coefficient with CVD risk of more than 0.3. A higher risk of CVD was also found to be associated with biochemical markers of cholesterol, low-density lipoprotein cholesterol, and blood sugar. Logistic regression analysis revealed 12 indicators to be influencing factors of CVD, including age, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the number of people aged >90 in the family. Hypertension, SBP, BMI, cholesterol, and blood glucose were associated with five or more other indicators.

Conclusions: The prevalence of CVD risk factors in Tianjin residents is relatively high. Family disease history and individual physical fitness indicators need to be taken into account during CVD screening and intervention, to reduce the risk of CVD.
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http://dx.doi.org/10.21037/atm.2020.03.139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210118PMC
April 2020

Combined non-invasive scan and biomarkers to identify independent risk factors in patients with mild coronary stenosis.

J Thorac Dis 2020 Mar;12(3):199-208

Graduate School, Tianjin Medical University, Tianjin 300070, China.

Background: Independent risk factors for major adverse cardiovascular events (MACEs) in patients with mild coronary stenosis are uncertain. This study aims to investigate predictive biomarkers for MACEs in patients with mild coronary stenosis.

Methods: Totally 381 patients with mild coronary stenosis were included and MACE incidences were recorded through a 24-month follow-up and 91 patients with unfavorable plaques characteristic are detected by CCTA. One unfavorable characteristic was recorded for 1 point and they were divided into three groups: high-risk group (HR, score =0), intermediate-risk group (IR, score =1) and low-risk group (LR, score/2). Specific blood biomarker measurements of high-sensitivity C-reactive protein (hs-CRP), matrix metallopeptidase 9 (MMP-9), and myeloperoxidase (MPO) were taken simultaneously.

Results: The mean age, hs-CRP and MPO levels in the HR and IR group were significantly higher than that in the LR group. A considerably higher level of MMP-9 showed in the HR group compared to the LR group. The incidence rates of MACE were remarkably higher in HR group than LR group and IR group. Kaplan-Meier survival analysis demonstrated that the cumulative event-free survival rate of HR was significantly higher than that in LR and IR group and there was no significant difference between LR and IR group. The univariate COX regression analysis indicated that the age, hs-CRP, MPO, and unfavorable plaque scores ≥2 were independent risk factors for MACEs.

Conclusions: High MPO levels were strongly correlated with MACEs in patients with mild coronary stenosis. Although confirmation is needed from larger trials, MPO could be a promising clinical tool to improve the risk stratification in patients with mild coronary stenosis and suggest strategies for the individualized prevention programs.
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http://dx.doi.org/10.21037/jtd.2020.01.71DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139078PMC
March 2020

Pharmacodynamics and metabonomics study of Tianma Gouteng Decoction for treatment of spontaneously hypertensive rats with liver-yang hyperactivity syndrome.

J Ethnopharmacol 2020 May 11;253:112661. Epub 2020 Feb 11.

Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.

Ethnopharmacological Relevance: Essential hypertension is a prevalence chronic cardiovascular disease, which is treated by traditional Chinese medicine (TCM) in China. Metabolomics approach has achieved more attention in pharmacology studies of natural products. Tianma Gouteng Decoction (TGD) is effective for the therapeutic of hypertension in China. We aimed to investigate antihypertension effect of TGD on spontaneous hypertension rat (SHR) with live-Yang hyperactivity hypertension (Gan Yang Shang Kang, GYSK) and explore the mechanism by metabolomics method.

Materials And Methods: After establishing the GYSK-SHR model by giving aconite decoction, rats were randomly divided into four groups including model group, TGD qd group (66.88 mg/kg, once a day), TGD bid group (33.44 mg/kg, twice a day), TGD tid group (22.29 mg/kg, three times a day). Blood pressure (BP) and indexes of renin-angiotensin-aldosterone system (RAAS system) were measured. Metabolic profiling of rat plasma samples was performed by UPLC-Q-TOF/MS, which was analyzed with principal component analysis (PCA) and partial least-squares-discriminate analysis (PLS-DA) to explore the relationship between metabolic pathways and hypertension.

Results: To better explain the role of TGD on hypertension, we detected three different frequencies of TGD treatment with equal dosage. TGD reduced the BP in GYSH-SHR model and regulated the serum levels of NE, Ang II, ET, 5-HT, CRP, RENIN and ALD especially at TGD bid group. By UPLC-Q-TOF/MS analysis, we found 47 potential biomarkers in GYSK-SHR rats from the plasma metabolites, among which 15 biomarkers were regulated by TGD. Consisted with the antihypertension activity, TGD bid group showed the significantly moderating effect on the regulating biomarkers.

Conclusions: TGD exhibited the antihypertensive activity at the frequency of administration twice a day, which had the association with RAAS system and mediated 15 biomarkers by regulating metabolisms of glycerol phospholipid, sphingomyelin, energy and amino acid.
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http://dx.doi.org/10.1016/j.jep.2020.112661DOI Listing
May 2020

Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies.

Diabetol Metab Syndr 2019 19;11:110. Epub 2019 Dec 19.

2Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China.

Background: The optimal revascularization technique in diabetic patients with complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD), remains controversial. The current study aimed to compare adverse clinical endpoints of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM).

Methods: Relevant studies were found from MEDLINE, OVID, Science Direct, Embase and the Cochrane Central database from January 2010 to April 2019. Risk ratio (RR) with 95% confidence interval (CI) was used to express the pooled effect on discontinuous variables. Outcomes evaluated were all-cause mortality, major adverse cardiac/cerebrovascular events (MACCE), cardiac death, myocardial infarction, stroke, and repeat revascularization.

Results: Sixteen studies were included (18,224 patients). PCI was associated with the increase risk for MACCE (RR 1.59, 95% CI 1.38-1.85), cardiac death (RR 1.76, 95% CI 1.11-2.80), MI (RR 1.98, 95% CI 1.53-2.57), repeat revascularization (RR 2.61, 95% CI 2.08-3.29). The risks for all-cause mortality (RR 1.23, 95% CI 1.00-1.52) and stroke (RR 0.71, 95% CI 0.48-1.03) were similar between two strategies. Stratified analysis based on studies design and duration of follow-up showed largely similar findings with the overall analyses, except for a significant increased risk of all-cause mortality (RR 1.32, 95% CI 1.04-1.67) in long-term group, and CABG was associated with a higher stroke rate compared to PCI, which are results that were found in RCTs (RR 0.47, 95% CI 0.28-0.79) and mid-term groups (RR 0.39, 95% CI 0.23-0.66).

Conclusions: CABG was superior to PCI for diabetic patients with complex CAD (including left main CAD and/or MVD), but might be associated with a higher risk of stroke mid-term follow-up. PROSPERO CRD 42019138505.
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http://dx.doi.org/10.1186/s13098-019-0506-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923849PMC
December 2019

Prognostic Value of Lipoprotein(a) Levels in Patients Undergoing Coronary Angiography for Premature Acute Coronary Syndromes.

Angiology 2020 Feb 13;71(2):160-166. Epub 2019 Nov 13.

Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.

Little is known about the association between lipoprotein(a) [Lp(a)] levels and future ischemic cardiovascular events in patients with premature acute coronary syndrome (ACS). A total of 1464 consecutive patients who underwent coronary angiography for premature ACS (males <45 years and females <55 years) were enrolled in this study. Patients were divided into quartiles according to serum Lp(a) levels (Q1: ≤11.1 nmol/L; Q2: 11.1-27.7 nmol/L; Q3: 27.7-79.3 nmol/L; and Q4: >79.3 nmol/L). Major adverse cardiovascular events (MACEs) increased with Lp(a) quartiles after 2-year follow-up (among quartiles, respectively; = .001). Kaplan-Meier curves revealed significant differences in event-free survival rates among Lp(a) quartile groups ( = .001). Multivariate Cox proportional hazards regression analysis indicated that serum Lp(a) level was an independent predictor of MACE either as a continuous variable (hazard ratio [HR]: 1.002, 95% confidence interval [CI]: 1.001-1.004; = .009) or as a categorical variable (HR: 1.443, 95% CI: 1.074-1.937; = .015). Furthermore, Lp(a) levels (as a variable) significantly improved the prognostic value for MACE. These findings suggest that Lp(a) measurement has value for cardiovascular risk stratification in patients with premature ACS.
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http://dx.doi.org/10.1177/0003319719886493DOI Listing
February 2020

[Expressions of CD4CD45RAT cells and CD4CD45ROT cells in peripheral blood of patients with acute coronary syndrome and their significance].

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2019 Sep;31(9):1133-1136

Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China. Corresponding author: Zhang Jingxia, Email:

Objective: To investigate the expressions of CD4CD45RAT cells and CD4CD45ROT cells in peripheral blood of patients with acute coronary syndrome (ACS) and their significance.

Methods: A case-control study was conducted. Ninety-four patients receiving coronary angiography (CAG) admitted to Tianjin Chest Hospital from March 5th to April 27th in 2018 were enrolled. They were divided into non-coronary heart disease (CHD) group (n = 12), unstable angina pectoris (UAP) group (n = 27), acute non-ST elevation myocardial infarction (NSTEMI) group (n = 27) and acute ST elevation myocardial infarction (STEMI) group (n = 28) according to the patients' symptoms, electrocardiogram, troponin test and angiographic results. General data, blood routine parameters, and biochemical indicators were collected. The ratios of CD4CD45RAT cells and CD4CD45ROT cells were determined by flow cytometry. Multivariate Logistic regression was used to evaluate whether CD4CD45RAT cells and CD4CD45ROT cells were associated with STEMI.

Results: Ninety-four patients were included initially. After excluding the patients who died during the intervention, 93 patients were enrolled in the data analysis finally, with 12 patients in the non-CHD group, 27 patients in the UAP group, and the same as the NSTEMI group and the STEMI group. Compared with the non-CHD group, white blood cell count (WBC) was decreased (×10/L: 6.03±1.30 vs. 6.60±1.30, P < 0.05), and lymphocyte ratio was increased (0.273±0.059 vs. 0.269±0.070, P > 0.05) in patients of the UAP group; however, in the NSTEMI group and STEMI group, WBC was increased (×10/L: 8.29±2.28, 9.86±2.76 vs. 6.60±1.30, both P < 0.05), and lymphocyte ratio was decreased (0.236±0.076, 0.173±0.094 vs. 0.269±0.070, P > 0.05 and P < 0.05), especially in the STEMI group [WBC (×10/L): 9.86±2.76 vs. 6.60±1.30, lymphocyte ratio: 0.173±0.094 vs. 0.269±0.070, both P < 0.05]. There was no significant difference in biochemical indicators among all of the groups. Flow cytometry results showed that the ratios of CD4CD45ROT cells in the UAP group and NSTEMI group were higher than those in the non-CHD group (0.323±0.074, 0.319±0.078 vs. 0.314±0.058, both P > 0.05); however, the ratio of CD4CD45ROT cells in the STEMI group showed a decreased tendency (0.270±0.057 vs. 0.314±0.058, P > 0.05), and it was significantly lower than that in the UAP group and the NSTEMI group (0.270±0.057 vs. 0.323±0.074, 0.319±0.078, both P < 0.05). There was no significant difference in the ratio of CD4CD45RAT cells among all of the groups. Multivariate Logistic regression analysis showed that CD4CD45RAT cells ratio was not significantly correlated with the occurrence of STEMI [odds ratio (OR) = 0.976, 95% confidence interval (95%CI) was 0.907-1.050, P = 0.518], but CD4CD45ROT cells ratio was significantly correlated with the occurrence of STEMI (OR = 0.888, 95%CI was 0.821-0.961, P = 0.003).

Conclusions: There was no significant difference in the ratio of CD4CD45RAT cells among UAP, NSTEMI and STEMI patients, and CD4CD45ROT cells ratio in the STEMI group was significantly lower than that in the UAP group and NSTEMI group. CD4CD45ROT cells ratio may be risk factor of STEMI.
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http://dx.doi.org/10.3760/cma.j.issn.2095-4352.2019.09.015DOI Listing
September 2019
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