ISSN 1671-5411 CN 11-5329/R

2017 Vol. 14, No. 12

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Electrocardiographic measures of repolarization dispersion and their relationships with echocardiographic indices of ventricular remodeling and premature ventricular beats in hypertension
Ana Ciobanu, Gary Tse, Tong Liu, Maria V Deaconu, Gabriela S Gheorghe, Adriana M Ilieşiu, Ioan T Nanea
2017, 14(12): 717-724. doi: 10.11909/j.issn.1671-5411.2017.12.001
Objective To examine the relationship between Tpeak- Tend interval (Tpe) and Tpe/QT ratio with occurrence of ventricular premature beats (VPBs) and left ventricular remodeling in hypertension. Methods A total of 52 patients with mild to moderate essential hypertension were included, undergoing echocardiography and 24-hours Holter monitoring. Ventricular remodeling was assessed by left ventricular mass index (LVMI) using the Devereux formula and diastolic function by transmittal E and A wave velocities and E/A ratio. Tpe was measured in the precordial leads. The end of the T wave was set by the method of the tangent to the steepest descending slope of the T wave. Results Tpe and Tpe/QT in leads V2 (r = 0.33, P = 0.01; r = 0.27, P = 0.04 respectively) and V3 (r = 0.40, P = 0.002; r = 0.40, P = 0.003, respectively) correlated significantly with LVMI. A significant inverse relationship was observed between E/A ratio and QT (r = -0.33, P = 0.01), Tpe in V3 (r = -0.39, P = 0.003) and Tpe/QT in V3 (r = -0.31, P = 0.02). Tpe in V3, V5, mean Tpe and maximum Tpe with cut-off values of 60 ms, 59 ms, 62 ms and 71 ms, respectively, associated with the occurrence of ventricular premature beats. Conclusions The repolarization parameters Tpe interval and Tpe/QT ratio correlate with LVMI and indices of left ventricular diastolic function and show better predictive values than traditional parameters such as QT interval and QT dispersion. Lead V3 is the best lead for measuring Tpe and Tpe/QT. These ECG indices can therefore be used in clinical practice to monitor LV remodeling and predict occurrence of VPBs.
Dual versus single antiplatelet therapy for patients with long-term oral anticoagulation undergoing coronary intervention: a systematic review and meta-analysis
Jing–Jing YU, Chan ZOU, Wen–Yu LIU, Guo–Ping YANG
2017, 14(12): 725-736. doi: 10.11909/j.issn.1671-5411.2017.12.002
Objective The main aim of this meta-analysis is to compare the efficacy and safety of dual versus single antiplatelet therapy for patients taking oral anticoagulation (OAC) after coronary intervention. Background The optimal regimen remains controversial patients taking OAC after coronary intervention. Methods PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for eligible studies including data of triple therapy (TT) versus OAC plus single antiplatelet therapy for patients requiring OAC after coronary intervention. The primary outcome was major adverse cardiac and cerebrovascular event (MACCE). The safety outcome was major bleeding. Results Fourteen studies with 32825 patients were included. Among prospective studies, patients with TT had a trend toward a higher risk of major bleeding [odds ratios (OR): 1.56, 95% confidence interval (CI): 0.98–2.49, P = 0.06] and a markedly higher risk of all-cause death (OR; 2.11, 95% CI: 1.10–4.06 P = 0.02) compared with OAC plus clopidogrel. Meanwhile, TT was associated with decreased risks of MACCE (OR: 0.63, 95% CI: 051–0.77 P P = 0.04), and stroke/transient ischemic attack (TIA)/peripheral embolism (PE) (OR: 0.29, 95% CI: 0.09–0.96, P = 0.04) compared with OAC plus aspirin.
Predictors of super-response to cardiac resynchronization therapy: the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing
Han JIN, Min GU, Wei HUA, Xiao–Han FAN, Hong–Xia NIU, Li–Gang DING, Jing WANG, Cong XUE, Shu ZHANG
2017, 14(12): 737-742. doi: 10.11909/j.issn.1671-5411.2017.12.003
Background Super-responders (SRs) are defined as patients who show crucial cardiac function improvement after cardiac resynchronization therapy (CRT). The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association (NYHA) functional class ≥ 1, a decrease in left ventricular end-systolic volume (LVESV) ≥ 15%, and a final left ventricular ejection fraction (LVEF) ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter (LAD), LVESV, left ventricular end-diastolic volume (LVEDV) and higher LVEF than the non-super-responders (non-SRs). The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) was higher in SRs than non-SRs. Most SRs had Biventricular (BiV) pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independent predictors of SRs were lower LVEDV [odd ratios (OR): 0.93; confidence intervals (CI): 0.90–0.97], use of ACEI/ARB (OR: 0.33; CI: 0.13–0.82) and BiV pacing percentage greater than 98% (OR: 0.29; CI: 0.16–0.87).Conclusion Patients with a better compliance of ACEI/ARB and a less ecstatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.
Effect of advanced age on plasma homocysteine levels and its association with ischemic stroke in non-valvular atrial fibrillation
Yan YAO, Li–Jian GAO, Yong ZHOU, Jing–Hua ZHAO, Qiang LV, Jian–Zeng DONG, Mei–Sheng SHANG
2017, 14(12): 743-749. doi: 10.11909/j.issn.1671-5411.2017.12.004
Background Elevated homocysteine (Hcy) has been reported to be associated with cardiovascular events in atrial fibrillation (AF) patients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of advanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients. Methods A total of 2562 consecutive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated. Results Plasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65–74 years and aged over 75 years (15.7 ± 4.6 μmol/L, 17.1 ± 4.9 μmol/L, both P P P = 0.002] and age ≥ 75 years (OR: 2.637, 95% CI: 1.605–4.335, P Conclusions Advanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.
Congenital left ventricular aneurysms and diverticula: an entity in search of an identity
Marc-Alexander Ohlow
2017, 14(12): 750-762. doi: 10.11909/j.issn.1671-5411.2017.12.005
Congenital left ventricular aneurysm or diverticulum are rare cardiac malformations described in 809 cases since the first description in 1816, being associated with other cardiac, vascular or thoraco-abdominal abnormalities in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. In an experimental study, targeted knockdown of cardiac troponin T in the chick was performed at day 3, after the heart tube has formed. Morpholino treatment of gene TNNT2 at this stage led to the development of left ventricular diverticula (LVD) in the primitive left ventricular wall. Diagnosis of left ventricular aneurysms (LVA)/LVD can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most of LVA and LVD are asymptomatic or may cause systemic embolization, congestive heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies (echocardiography, magnetic resonance imaging or left ventricular angiography) visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications, options include surgical resection (especially in symptomatic patients), anticoagulation after systemic embolization, radiofrequency ablation or implantation of an ICD in case of symptomatic ventricular tachycardias, and occasionally combined with class I- or III-antiarrhythmic drugs. Cardiac death occurs usually in childhood, is significantly more frequent in LVA patients and caused by congestive heart failure in most of the cases, whereas patients diagnosed with LVD died more frequently from rupture of the LVD.
Transcatheter Valve-in-Valve implantation after late migration of balloon expandable Sapien- XT prosthesis in a severe pure aortic regurgitation case
Emmanouil Chourdakis, Ioanna Koniari, George Hahalis, Nikolas Kounis, Karl Eugen Hauptmann
2017, 14(12): 763-765. doi: 10.11909/j.issn.1671-5411.2017.12.006
Transcatheter aortic valve implantation (TAVI) is an off label therapy in patients with severe, symptomatic, native aortic regurgitation (NAR) and porcelain aorta. Prosthetic valve migration (PVM) after TAVI occur with an incidence of 1.3% per patient-year. The Valve-in-Valve (TV-in-TV) implantation in an overlapping fashion is used as a rescue therapy to avoid cardiac surgery due to valve-malapposition. We report a PVM occurring late, i.e., 7 days after TAVI treated with a second valve implantation via transfemoral approach.
A meta-analysis of soluble suppression of tumorigenicity 2 (sST2) and clinical outcomes in pulmonary hypertension
King Sum Luk, Christina Ip, Meng–Qi GONG, Sunny Hei WONG, William KK Wu, Mei DONG, Guang–Ping LI, Ka Pang Chan, Yi–Mei DU, Tong LIU, Martin CS Wong, David Shu, Cheong Hui, Gary Tse, International Heath Informatics Study (IHIS) Network
2017, 14(12): 766-771. doi: 10.11909/j.issn.1671-5411.2017.12.007
Letter to Editor
Spontaneous diffuse vasospasm simultaneously found at left main trunk, left anterior descending, left circumflex and right coronary arteries
Yue–Hai WANG, Guang –Yong HUANG, Xiao–Hua WANG
2017, 14(12): 772-775. doi: 10.11909/j.issn.1671-5411.2017.12.008
Meta-analysis of T-wave indices for risk stratification in myocardial infarction
Gary Tse, Cheuk Wai Wong, Meng–Qi GONG, Lei MENG, Konstantinos P Letsas, Guang–Ping LI, Paula Whittaker, Aishwarya Bhardwaj, Abhishek C Sawant, William KK Wu, Sunny Hei Wong, Jayaprakash Shenthar, Lap Ah Tse, Martin CS Wong, Adrian Baranchuk, Gan–Xin YAN, Tong LIU, International Health Informatics Study (IHIS) Network
2017, 14(12): 776-779. doi: 10.11909/j.issn.1671-5411.2017.12.009
Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure
Wei YAN, Jian–Zhong LI, Kun–Lun HE
2017, 14(12): 780-780. doi: 10.11909/j.issn.1671-5411.2017.12.010
A reader read our article published in Journal of Geriatric Cardiology which entitled “Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure”, and put forward some questions. We have read with great interest the reader’s letter that addresses several important topics.