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Coverpage
July-September 2021
Volume 6 | Issue 3
Page 149-197
Online since Thursday, September 30, 2021
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REVIEW ARTICLE  
P. 149
Yi Zhang, Qiu-Tong Li, Tian-Tian Li
DOI:10.4103/2470-7511.327242  
Background and Objectives: Cardiovascular diseases (CVDs) are associated with a heavy health burden globally. Although there are several studies and reviews with a focus on the effects of ambient particulate matter on CVDs, presently, review of the association between particulate matter components and cardiovascular biomarkers has not been reported. Therefore, in this study, we reviewed the effects of particulate matter exposure on the levels of cardiovascular biomarkers. Methods: PubMed, Embase, and Web of Science databases were searched for related studies published between January 1, 2010, and May 30, 2021, using keywords, including particle, particulate, constituent, component, composition, cardiovascular biomarker, inflammation, oxidative stress, coagulation vasoactivity, and lipid metabolism. Results: Ten studies, which met the inclusion criteria, highlighted the existence of significant associations between particulate matter components and the levels of cardiovascular biomarkers, including lipid, inflammation and coagulation biomarkers, etc. However, multicenter studies evidence regarding the effects of long-term exposure to particulate matter components on cardiovascular biomarkers is still lacking. Further, studies with a focus on proteomics, and metabolomics of cardiovascular biomarkers owing to particulate matter exposure are also scarce. Conclusions: Exposure to particulate matter components was found to be significantly associated with cardiovascular biomarkers. However, in future, it would be necessary to conduct multicenter studies on the effects of long-term exposure to particulate components on the levels of cardiovascular biomarkers.
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META-ANALYSIS Top
P. 156
Yu-Cheng Wang, Ming-Hui Li, Ying Yu, Hui Shi, Rui-Zhen Chen
DOI:10.4103/2470-7511.327238  
Background and Objectives: Sodium-glucose co-transporter 2 inhibitors (SGLT2is) significantly reduce the risk of cardiovascular events in patients with type 2 diabetes mellitus (T2DM). However, the effectiveness of SGLT2is in heart failure (HF) treatment has not yet been established. The aim of this meta-analysis was to assess the efficacy and safety of SGLT2is in HF treatment by focusing on cardiovascular death (CVD), hospitalization for HF (HHF), and a composite of CVD and HHF. Methods: We searched literature sources in PubMed, EMBASE, and Cochrane Library up until December 20, 2020. Only randomized controlled trials were included in this meta-analysis. We compared the treatment and placebo groups in terms of their associated risks of CVD and HHF and their safety endpoints. The Cochrane tool for assessing risk of bias in randomized trials was applied. Results: The 10 selected studies included 17,043 HF patients and dapagliflozin, empagliflozin, canagliflozin, ertugliflozin, and sotagliflozin as experimental arms. At least 4 included studies were with high quality. For CVD, HHF, and their composite, the pooled risk ratio estimates were 0.87 (95% confidence interval [CI], 0.78–0.96; P = 0.004), 0.70 (95% CI, 0.65–0.76; P < 0.001), and 0.76 (95% CI, 0.71–0.81; P < 0.001), respectively. The incidence of volume depletion, hypoglycemia events, fractures, acute renal injury, and urogenital tract infection was not significantly higher in the SGLT2i group than in the placebo group. Stratified analyses showed similar efficacy and safety results for HF patients with T2DM, those without T2DM, and those being treated with different types of SGLT2is. Conclusions: This meta-analysis demonstrated that various SGLT2is significantly decreased the risks of CVD and HHF in HF patients with and without T2DM. It also showed that clinical administration of SGLT2is was relatively safe in terms of the aforementioned risk factors. SGLT2is might embrace broader clinical application in future HF treatment.
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ORIGINAL ARTICLES Top
P. 166
Hui-Wen Zhang, Yuan-Lin Guo, Cheng-Gang Zhu, Na-Qiong Wu, Ying Gao, Qian Dong, Jing Sun, Jian-Jun Li
DOI:10.4103/2470-7511.327240  
Background and Objectives: Patients with nonobstructive coronary artery disease (NOCAD) have an increased risk of cardiovascular events (CVEs) compared to that in individuals with normal or near-normal coronary arteries (NNCAs) and even a similar risk to that in individuals with obstructive coronary artery disease (OCAD). However, the predictors for a worse outcome in patients with NOCAD are not fully determined. This study aimed to investigate the association of high-sensitive C-reactive protein (hs-CRP) and CVEs in patients with NOCAD. Materials and Methods: In total, 4662 patients with coronary artery angiography were enrolled and followed up for CVE. Patients were classified as having NNCA (<20% stenosis, n = 698, 15.0%), NOCAD (20%–49% stenosis, n = 639, 14.3%), and OCAD (≥50% stenosis, n = 3325, 70.7%) and then further subdivided into three groups based on their baseline hs-CRP level (<1, 1–3, and >3 mg/L). Proportional hazards models were used to assess the risk of CVEs. Results: Over an average 13403 person-year follow-up, 338 patients experienced CVEs. Patients with NOCAD and OCAD had a higher rate of CVE than those with NNCA (P < 0.05). The CVE risk was significantly higher in NOCAD (hazard ratio [HR]: 2.31, 95% confidence interval [CI]: 1.30–4.01, P = 0.004) and OCAD (HR: 3.09, 95% CI: 1.88–5.07, P < 0.001) patients than in NNCA patients. Moreover, elevated hs-CRP levels were associated with an incremental rate of CVE (P < 0.05). Conclusions: Patients with NOCAD had worse outcomes and elevated hs-CRP levels were positively associated with CVEs, which potentially helps assess risk in NOCAD patients.
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P. 174
Shen-Gen Liao, Rong-Rong Gao, Iokfai Cheang, Xin-Yi Lu, Yan-Li Zhou, Hai-Feng Zhang, Wen-Ming Yao, Xin-Li Li
DOI:10.4103/2470-7511.327243  
Background and Objective: Clinical studies have suggested that low tri-iodothyronine (T3) syndrome negatively affects the clinical outcomes of patients with acute heart failure (AHF). The aim of this prospective cohort study was to evaluate the effect of low T3 syndrome in terms of prognosis and risk-predictive potential in AHF. Methods: A prospective observational cohort study was conducted from April 2012 to August 2016 in Nanjing, China. All clinical baseline characteristics were retrieved from electronic medical records. Low T3 syndrome was defined by a low free T3 level (<3.1 pM) accompanied by a normal thyroid-stimulating hormone level. The association between the free T3 level and mortality and the incremental risk prediction were estimated in Cox regression adjusted models. Results: In total, 312 patients with AHF for whom detailed thyroid hormone profiles were available were prospectively enrolled. Seventy-two patients exhibited low T3 syndrome. Over a median follow-up period of 35 months, 121 cumulative deaths occurred. Cardiovascular death was observed in 94 patients. After extensive adjustment for confounders, the low T3 syndrome-associated hazard ratios (95% confidence intervals) were 1.74 (1.16–2.61, P = 0.007) for all-cause mortality and 1.90 (1.21–2.98, P = 0.005) for cardiovascular mortality. The restricted cubic splines suggested a negative linear relationship between the free T3 level and mortality risk. Considering reclassification, adding low T3 syndrome to the fully adjusted model improved the risk prediction for all-cause mortality (integrated discrimination improvement [IDI]: 2.0%, P = 0.030; net reclassification improvement [NRI]: 8.9%, P = 0.232) and cardiovascular mortality (IDI: 2.5%, P = 0.030; NRI: 21.3%, P = 0.013). Conclusions: Low T3 syndrome reclassified risk prediction for mortality beyond traditional risk factors for patients with AHF.
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P. 181
Li-Fan Yang, Wen-Zhi Pan, Li-Hua Guan, Xiao-Chun Zhang, Lei Zhang, Sha-Sha Chen, Da-Xin Zhou, Jun-Bo Ge
DOI:10.4103/2470-7511.327241  
Objectives: Patients undergoing trans-carotid transcatheter aortic valve replacement (TC-TAVR) are more likely to suffer from a stroke because of cerebral blood hypoperfusion and blood occlusion caused by the introducer sheath compared with the trans-femoral (TF) approach. The present study aimed to compare the incidence of stroke between the TC and TF approaches and explore the causes of stroke after TAVR. Methods: We retrospectively reviewed the medical records of 414 consecutive patients with severe aortic valve stenosis who underwent TC- or TF-TAVR at our center from October 2010 to November 2019; these patients were included in this observational study. The clinical data, such as the incidence of stroke, were compared between TC- and TF-TAVR patients. The correlation between carotid artery blood block interval (CABBI) and neurological events was also analyzed. The study was approved by the Ethics Committee of Zhongshan Hospital of Fudan University (approval No. YL2014-32). Results: Patients undergoing TC-TAVR had a significantly higher incidence of stroke than those undergoing TF-TAVR (12.5% vs. 0, P < 0.001), whereas the baseline data and the incidence of other complications did not differ significantly between the patients undergoing TC- and TF-TAVR (P > 0.05). Moreover, in TC-TAVR patients, the average CABBI of stroke was significantly longer than that of nonstroke patients (61.7 ± 20.7 min vs. 25.1 ± 1.6 min, P = 0.001). The number of patients with CABBI >30 min in the stroke group was greater than that in the nonstroke group (P < 0.001). Conclusions: In the absence of the cerebral and carotid artery evaluation before TAVR, surgeons should take into consideration the time of CABBI <30 min to avoid the possibility of stroke.
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STUDY DESIGN Top
P. 187
Ding-Cheng Xiang, Yin-Zi Jin, Wei-Yi Fang, Xi Su, Bo Yu, Yan Wang, Wei-Min Wang, Le-Feng Wang, Hong-Bing Yan, Xiang-Hua Fu, Zhi-Jie Zheng, Kenneth A Labresh, Yong Huo, Jun-Bo Ge
DOI:10.4103/2470-7511.327239  
Background: The National Chest Pain Centers Program (NCPCP) is the largest nationwide, hospital-based, multifaceted, continuous quality improvement initiative, which aims to monitor and improve the quality of care for patients with acute chest pain. The accreditation of the standardized chest pain center is central to the project. The purpose of establishing chest pain centers is to develop a mechanism for “sending acute chest pain patients to a hospital with capabilities for the best treatment in the shortest time possible.” Objectives: This study aims to evaluate the effectiveness and implementation of the chest pain center accreditation and to identify factors that may influence its implementation in local settings. Study Design and Methods: Hospitals that have been accredited between January 2016 and September 2020 will be recruited in this study. We will conduct a self-controlled retrospective cohort study by comparing the care performance before, during, and after the accreditation. Measures for care performance will be selected based on the American College of Cardiology/American Heart Association clinical practice guidelines, which will be divided into prehospital processes, in-hospital processes, and in-hospital outcomes. For the implementation of the chest pain center accreditation, we will use a modified reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to investigate the implementation process, and the consolidated framework for implementation research will be used to identify factors that emerge within the local context and influence the implementation fidelity and feasibility. Progress to Date: As of September 2020, there were 4,621 hospitals that registered the NCPCP, of which 1,507 hospitals were accredited. A total of 5,228,973 patients with a primary diagnosis on admission were enrolled from the registered hospitals, among which 34.6% were acute coronary syndromes. Conclusions: In this study, we proposed recommendations for improving the implementation of chest pain center accreditation, which will improve the quality of care for patients with acute chest pain and promote the sustainable development of chest pain center.
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