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2023, Volume 20,  Issue 2

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Arterial stiffness expressed as brachial–ankle pulse wave velocity and gait assessment independent of lower extremity strength: a cross-sectional study in the older men population
Tae Kyung Yoo, Seunghee Lee, Sae-Jong Park, Jong-Young Lee
2023, 20(2): 91-99. doi: 10.26599/1671-5411.2023.02.001
 BACKGROUND  Older men are more vulnerable to fatal falls than women, and gait disturbances contribute to the risk of falls. Studies have assessed the association between arterial stiffness and gait dysfunction, but the results have been inconclusive. This study aimed to conduct a cross-sectional analysis to evaluate the association between brachial–ankle pulse wave velocity (baPWV) and gait assessment in older men.  METHODS  Data from the 2014–2015 Korea Institute of Sport Science Fitness Standards project were used for the analysis. The inclusion criteria were men aged > 65 years with gait assessment [the 30-s chair stand test (30s-CST), the timed up and go (TUG) test, the figure-of-8 walk (F8W) test, the 2-min step test (2MST), and the 6-min walk test (6MWT)] and baPWV measurement data. Generalized linear regression analysis was conducted with multiple confounding factor adjustments, including lower extremity isometric strength.  RESULTS  A total of 291 participants were included in the analysis. The mean age was 71.38 ± 4.40 years. The mean values were as follows: (1) 30s-CST, 17.48 ± 5.00; (2) TUG test, 6.01 ± 1.10 s; (3) F8W test, 25.65 ± 4.71 s; (4) 2MST, 102.40 ± 18.83 per 2 min; and (5) 6MWT, 500.02 ± 85.65 m. After multivariable adjustment, baPWV was associated with the 6MWT (β = −0.037, 95% CI: −0.072–−0.002), TUG test (β = 0, 95% CI: 0.000–0.001), and F8W test (β = 0.002, 95% CI: 0.000–0.004). baPWV was not associated with the 30s-CST and 2MST.  CONCLUSIONS  The current study showed a statistically significant association between gait assessments and arterial stiffness, independent of lower extremity strength. However, this association was modest. Future prospective studies are needed to elucidate the complex relationship between arterial stiffness and gait dysfunction.
Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population
Yu-Qi JIANG, Huan-Rui ZHANG, Bo-Nan LIU, Tian-Wen LI, Jun-Feng JIANG, Wen TIAN
2023, 20(2): 100-108. doi: 10.26599/1671-5411.2023.02.005
 OBJECTIVE  To determine the role of ascending aorta dilatation in the relationship between pulse pressure (PP) and left ventricular (LV) hypertrophy.  METHODS  A total of 1556 Chinese elderly hypertensive patients were retrospectively studied. Transthoracic echocardiography was used to obtain the aortic and cardiac structure measurements. In addition, brachial blood pressure was measured, and total arterial compliance, systemic vascular resistance, arterial elastance, and end-systolic LV elastance were calculated. The participants were divided into four groups according to the status of ascending aortic diameter and PP.  RESULTS  LV mass index increased in succession in the four groups, i.e., the group with the normal aorta and lower PP, with the normal aorta and higher PP, with aortic dilatation and lower PP, and with aortic dilatation and higher PP (Ptrend < 0.001). Total arterial compliance−1, arterial elastance, and end-systolic LV elastance were slightly higher in the individuals with normal aorta compared to those with aortic dilatation, regardless of PP being lower or higher (P < 0.01). Compared to the group with the normal aorta and lower PP, individuals with aortic dilatation had a significantly increased multivariable adjusted risk of LV hypertrophy, and higher PP further exacerbated this risk [aortic dilatation with lower PP (OR = 1.75, 95% CI: 1.01–3.04) and aortic dilatation with higher PP (OR = 3.42, 95% CI: 2.03–5.77)]. In the relation between PP and LV mass index (β = 0.095, P < 0.001), -41.3% of the total effect was attributable to mediation by ascending aortic diameter (P < 0.0001).  CONCLUSIONS  In Chinese elderly patients with hypertension, ascending aorta dilatation could reduce the influence of elevated PP on LV hypertrophy.
Different clinical characteristics and outcomes of hypertrophic cardiomyopathy with and without hypertension: seeking the truth
Yu ZHANG, Ming-Hao LIU, Mo ZHANG, Gui-Xin WU, Jie LIU, Ji-Zheng WANG, Xiao-Lu SUN, Wen JIANG, Dong WANG, Lian-Ming KANG, Xue-Yi WU, Yu-Bao ZOU, Lei SONG
2023, 20(2): 109-120. doi: 10.26599/1671-5411.2023.02.007
 OBJECTIVE  To determine the different clinical characteristics and outcomes of hypertrophic cardiomyopathy (HCM) patients with and without hypertension (HT).  METHODS  A total of 696 HCM patients were included in this study and all HCM diagnoses were confirmed by the genetic test. Patients were analyzed separately in the septal reduction therapy (SRT) cohort and the non-SRT cohort. The primary endpoint was cardiovascular death and the secondary endpoint was all-cause death. Outcome analyses were conducted to evaluate the associations between HT and outcomes in HCM. Medications before enrollment and at discharge were collected in the post-hoc analyses.  RESULTS  HCM patients without HT were younger, had a lower body mass index, were more likely to have a family history of HCM, and had a smaller left ventricular (LV) end-diastolic diameter than those with HT in both cohorts. A thicker LV wall, a higher level of N-terminal pro-B-type natriuretic peptide, and a higher extent of LV late gadolinium enhancement were additionally observed in patients without HT in the non-SRT cohort. The presence of HT did not alter the distribution pattern of late gadolinium enhancement, as well as the constituent ratio of eight disease-causing sarcomeric gene variants in both cohorts. Outcome analyses showed that in the non-SRT cohort, patients without HT had higher risks of cardiovascular death (HR = 2.537, P = 0.032) and all-cause death (HR = 3.309, P = 0.032). While such prognostic divergence was not observed in the SRT cohort. Further post-hoc analyses in the non-SRT cohort found that patients without HT received fewer non-dihydropyridine calcium channel blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before enrollment and at discharge.  CONCLUSIONS  HCM patients without HT had worse clinical conditions and higher mortality than patients with HT overall, which may result from active medical therapy in HT patients. Active SRT may have a substantial de-risking effect on patients meeting the indications.
Effect of renal denervation for patients with isolated systolic hypertension: a systematic review and meta-analysis
Le LI, Yu-Long XIONG, Bin TU, Shang-Yu LIU, Zhen-Hao ZHANG, Zhao HU, Yan YAO
2023, 20(2): 121-129. doi: 10.26599/1671-5411.2023.02.003
 BACKGROUND  Renal denervation (RDN) is a promising treatment based on catheter intervention for patients with refractory hypertension. However, the effect in patients with isolated systolic hypertension (ISH) remains controversial. The aim of this meta-analysis was to determine the blood pressure lowing effect of RDN in patients with ISH compared with combined systolic/diastolic hypertension (CH) patients.  METHODS  PubMed, Embase, Cochrane and were searched for prospective clinical studies that included RDN. The outcomes of interest were the change of 24-hour ambulatory systolic blood pressure (SBP) from baseline. We used the fixed effects model to calculate weighted mean difference (WMD) with 95% confidence interval (CI).  RESULTS  Six trials were included, with 1405 participants, including 597 patients with ISH and 808 patients with CH. Mean follow-up was five months. The reduction of 24-hour ambulatory SBP was significantly greater for the CH patients than the ISH patients (WMD = 3.89, 95% CI: 2.32–5.45, P < 0.0001). RDN also showed a greater reduction in office SBP in the CH patients compared to the ISH patients (WMD = 10.24, 95% CI: 4.24–15.74, P = 0.0003). And the effect was independent of age, length of follow-up, and ablation device.  CONCLUSIONS  RDN provides superior blood pressure control in the CH patients compared with the ISH patients, and the CH patients may be the best suitable population for which RDN is indicated.
His-Purkinje conduction system pacing combined with atrioventricular node ablation improves quality of life in older patients with persistent atrial fibrillation refractory to multiple ablation procedures
Peng QI, Yi-Zhen YANG, Liang SHI, Yan-Jiang WANG, Ying TIAN, Ke-Xin YUAN, Xue-Feng CHEN, Shu-Ren LI, Yi DANG, Xing-Peng LIU
2023, 20(2): 130-138. doi: 10.26599/1671-5411.2023.02.006
 BACKGROUND  Recurrence of atrial fibrillation (AF) is common in patients with persistent AF even after multiple ablation procedures. His-Purkinje conduction system pacing (HPCSP) combined with atrioventricular node ablation (AVNA) is effective in managing patients with AF and heart failure. This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures, as well as evaluate the feasibility and safety of this therapy.  METHODS  Older patients (≥ 65 years) with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA. The success rates and complications were recorded. Pacing parameters, European Heart Rhythm Association (EHRA) scores, and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination.  RESULTS  Thirty-one patients were enrolled; of those, only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead. The success rates were 100% for HPCSP (22 cases with His bundle pacing, and 9 cases with left bundle branch pacing) and 93.3% (28/30) for AVNA, respectively. By the 6-month follow-up examination, EHRA scores improved significantly (3.00 ± 0.73 vs. 2.44 ± 0.63, P = 0.014) and AFEQT scores increased markedly (49.6 ± 20.6 vs. 70.9 ± 14.0, P = 0.001). No severe complications developed.  CONCLUSIONS  When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures, HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up. This therapy was proved to be safe and effective in this patient population.
Incidence, predictors and prognosis of acute kidney injury in acute ST-segment elevation myocardial infarction patients undergoing emergent coronary angiography/primary percutaneous coronary intervention
Jing TAN, Ying-Hua ZHANG, Jin SI, Ke-Ling XIAO, Qi HUA, Jing LI
2023, 20(2): 139-149. doi: 10.26599/1671-5411.2023.02.004
 BACKGROUND  Acute kidney injury (AKI) after coronary angiography (CAG) and primary percutaneous coronary intervention (PPCI) is frequently observed, and often interpreted as contrast induced-AKI. This study aimed to investigate the incidence, predictors and outcomes of AKI in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing emergent CAG/PPCI using the control group of STEMI patients who were not exposed to contrast agents within the first 72 h.  METHODS  We performed a retrospective analysis of 1670 STEMI patients. Of them, 673 patients underwent emergent CAG/PPCI, and 997 patients treated with thrombolysis or no reperfusion therapy who were not exposed to contrast material during the first 72 h. AKI was defined as an increase of serum creatinine ≥ 44.2 mmol/L or ≥ 25% from baseline within 72 h. Patents were then followed up for the occurrence of all-cause mortality for 40 months (interquartile range: 24–55 months).  RESULTS  After propensity score matching, 505 pairs of patients were matched. Overall, the incidence of AKI was 27.4%, and AKI rates were not significantly different in patients with and without emergent CAG/PPCI procedure (27.5% vs. 27.3%, P = 0.944). Multivariate logistic regression analysis identified that the independent predictors of AKI were female, elevated interleukin-6 level, decreased lymphocyte count, left ventricular ejection fraction < 50% and use of diuretics in patients with emergent CAG/PPCI. Patients with AKI than those without AKI experienced higher incidence of acute heart failure with Killip class III (9.4% vs. 3.3%, P = 0.005; 15.2% vs. 6.8%, P = 0.003, respectively) and mortality (5.8% vs. 1.4%, P = 0.014; 12.3% vs. 4.6%, P = 0.002, respectively) in patients with and without emergent CAG/PPCI. Multivariate Cox regression analysis confirmed that AKI was independently associated with long-term mortality rate at 40 months follow-up in patients with and without emergent CAG/PPCI (HR = 1.867, 95% CI: 1.086–3.210, P = 0.024; HR = 1.700, 95% CI: 1.219–2.370, P = 0.002, respectively).  CONCLUSIONS  Approximately 27.0% of STEMI patients experience AKI, which is strongly associated with an increased short- and long-term mortality regardless of emergent CAG/PPCI procedure. The development of AKI is mainly related to female gender, inflammation reaction, heart failure and use of diuretics in STEMI patients undergoing emergent CAG/PPCI.
A misdiagnosed transthyretin in an elderly with myocardial hypertrophy and atrioventricular block: a case report
Ming-Yue XU, Wei HUANG, Kan ZHANG, Dai ZHANG, Yun-Li XING
2023, 20(2): 150-154. doi: 10.26599/1671-5411.2023.02.009
Post-op cocaine use resulting in catastrophic cardiovascular compromise
Abhinav Karan, Aleem Azal Ali, Khadeeja Esmail, Temitope Akinjogbin, Sanjay Lamsal, Emil Missov
2023, 20(2): 155-158. doi: 10.26599/1671-5411.2023.02.002
The first attempt for closure of the patent foramen ovale under guidance of teleoperation ultrasonic robot: a case report
Yu WEI, Hao ZHOU, Mang-Xiang ZHAO, Chi WANG, Shuang-Yi WANG, Zhao-Kun DENG, Hang ZHU
2023, 20(2): 159-162. doi: 10.26599/1671-5411.2023.02.008