Decreased plasma nesfatin-1 levels in patients with acute myocardial infarction

Nesfatin-1 is a novel anorexigenic hormone which has close relationship with diabetes, obese, anorexia nervosa, psychiatric disorders and neurogenic diseases. The aim of our study was to evaluate levels of plasma nesfatin-1 among patients presenting with coronary artery disease and the correlation between nesfatin-1 levels and other clinical parameters. Fasting plasma levels of nesfatin-1 were tested in 48 acute myocardial infarction (AMI) patients, 74 stable angina pectoris (SAP) patients and 34 control subjects. All of them were examined by coronary angiography. The severity of coronary atherosclerosis was assessed using the Gensini score. Plasma nesfatin-1 levels were significantly lower in AMI group than SAP group or control group (0.91 ± 0.08 ng/mL vs. 0.98 ± 0.19 ng/mL and 1.09 ± 0.39 ng/mL, respectively, P < 0.05). In AMI patients, plasma nesfatin-1 levels were negatively correlated with high-sensitivity C-reactive protein, neutrophil% or Gensini scores. Such information implies that lower nesfatin-1 concentration may play a very important role in the development of AMI.     

急性心肌梗死患者肠道菌群多样性分析

目的 初步探究急性心肌梗死患者肠道菌群的多样性。方法 选择2015年6月至2016年3月于大连大学附属中山医院住院治疗的急性心肌梗死患者作为观察组,年龄51~70岁。选择同期经冠脉造影排除冠心病的住院患者为对照组,年龄51~70岁。排除近1个月内发生感染、炎性肠病及应用抗生素的患者。所有患者按性别与年龄分为A、B、C、D组。直接从患者粪便标本中提取细菌总DNA,PCR扩增后进行梯度凝胶电泳（DGGE）分析。结果 DGGE分析显示急性心梗患者肠道菌群丰度均较对照组下降。A组中观察组与对照组患者电泳条带数为(33.71±4.39) vs (38.71±2.56),t=－2.058,P=0.040;C组患者为(31.14±2.67) vs (35.29±3.55),t=－2.005,P=0.045;差异均具有统计学意义。B与D组中心梗患者肠道菌群丰度亦有下降趋势,但与对照组比差异无统计学意义。UPGAM法聚类分析显示除D组外,各组中观察组与对照组患者肠道菌群呈现分离现象;急性心梗患者肠道菌群有较高相似性,与非冠心病患者肠道菌群差异明显。结论 急性心梗与非冠心病患者肠道菌群存在差异,急性心梗患者肠道菌群多样性较低。肠道菌群改变可能与急性心肌梗死存在一定相关性。     

Transient reduction of autoantibodies against oxidized ldl in patients with acute myocardial infarction

Fifteen consecutive patients (mean age 66 ± 14, range 31–82) with an acute myocardial infarction (MI) suitable for thrombolytic therapy were included in this study. Autoantibodies against oxidized low-density lipoprotein (LDL) were determined by enzyme-linked immunosorbent assay (ELISA). Patients (n = 10) with marked elevation of the MB isoenzyme of creatinine kinase (CK-MB)-mass had significant decreases of oLDL-Ab during the acute phase, with a minimum after 8 h following the onset of thrombolytic therapy (within-group significance: p < .001; between groups: p = .01). Patients (n = 5) with CK-MB-mass values less than 70 ng/ml did not show this phenomenon. Furthermore, significant correlations existed between CK-MB-mass and oLDL-Ab after 6 and 8 h (n = 15; R = .72; P = .003) and the time of the highest CK-MB-mass values (after 12 h) and the time of the maximal decrease of oLDL-Ab (after 8 h) (r = .74; P = .003). Our observations provide further evidence for the release of free radicals and for increased lipid peroxidation during reperfusion after prolonged ischemia. The decrease of oLDL-Ab appears to be a marker for the severity of MI.     

C-反应蛋白在不同程度急性心梗患者中的相关性研究

目的：探讨C-反应蛋白（CRP）在急性心肌梗死患者中的变化及与心功能之间的关系。方法：选取121例急性心肌梗死（AMI）患者和50例健康对照者,酶联免疫吸附法（ELISA）检测血清C-反应蛋白（CRP）和B型钠尿肽（BNP）。结果：AMI患者血清CRP显著高于健康对照,AMI伴心功能III,IV级者血清BNP、CRP显著高于AMI伴心功能I,II级者。结论：血清CRP对于急性心肌梗死患者的心功能重要参考指标。     

C - 反应蛋白在不同程度急性心梗患者中的相关性研究

目的:探讨C-反应蛋白(CRP)在急性心肌梗死患者中的变化及与心功能之间的关系。方法:选取121例急性心肌梗死(AMI)患者和50例健康对照者,酶联免疫吸附法(ELISA)检测血清C-反应蛋白(CRP)和B型钠尿肽(BNP)。结果:AMI患者血清CRP显著高于健康对照,AMI伴心功能III,IV级者血清BNP、CRP显著高于AMI伴心功能I,II级者。结论:血清CRP对于急性心肌梗死患者的心功能重要参考指标。     

Detrimental effects of endogenous oestrogens on primary acute myocardial infarction among postmenopausal women

Objective

Traditionally, oestrogens were considered to be protective for the cardiovascular system for premenopausal women. Therefore, we conducted a retrospective case–control study to examine the association between endogenous oestrogens and acute myocardial infarction (AMI) risk among postmenopausal women.

Methods

A case–control study was performed among 30 primary AMI patients and 60 control subjects. Baseline characteristics data was collected and endogenous sex hormones levels were determined using chemoluminescence and radioimmunoassay methods. Conditional logistic regression models were developed with adjustment for confounders.

Results

Compared with controls, the circulating oestrone, oestradiol, androstenedione and testosterone levels were significantly higher in AMI patients (P < 0.05) while the sex hormone binding globulin (SHBG) level was lower (P < 0.05). Spearman correlation coefficients showed oestradiol was positively correlated with body mass index (BMI) and waist-to-hip ratio (WHR) in cases, but not in controls. In univariable conditional logistic regression models, oestrone, oestradiol, testosterone, WHR, BMI, diabetes and hypertension were all found to be positively associated with AMI (P < 0.05). After adjusting for these factors, oestradiol (odds ratio (OR) = 4.75; 95 % confidence interval (CI) = 1.07–21.10; P = 0.04) and WHR (OR = 6.46; 95 % CI = 1.09–38.39; P = 0.04) continued to demonstrate strong positive associations with AMI.

Conclusions

A higher level of oestradiol was potentially associated with primary AMI risk among postmenopausal women.     

急性心肌梗死患者肠道优势菌群分析

目的探讨急性心肌梗死患者肠道优势菌群的改变及其与疾病严重程度的关系。方法共筛选急性心肌梗死患者71名及正常健康体检者33名,急性心肌梗死患者根据是否心衰分为急性心肌梗死组36名和急性心肌梗死伴泵衰竭组35名,所有入选者收集大便及血清标本,分别采用qPCR及化学发光仪测定肠道优势菌群改变和血清脑钠肽前体及肌钙蛋白水平。结果急性心肌梗死患者肠道优势菌群显著改变,肠道肠杆菌以及肠球菌细菌数量较对照组显著增加,均与脑钠肽前体、肌钙蛋白、Killip分级显著正相关,而双歧杆菌、乳酸杆菌等细菌数量显著降低,与脑钠肽前体、肌钙蛋白、Killip分级显著负相关。结论急性心肌梗死患者呈现典型的肠道菌群紊乱,且与患者疾病严重程度相关。     

Chronobiology of acute myocardial infarction molecular biology

The incidence of heart attacks increases in the early morning. This circadian oscillation is closely related to the function of the internal biological clock. In this article, we review the chronobiology of acute myocardial infarction (AMI) from the viewpoint of molecular biology.     

Dramatic changes in catestatin are associated with hemodynamics in acute myocardial infarction

Acute myocardial infarction (AMI) is characterized by complex neuroendocrine activation. To investigate catestatin profiles, serial catestatin levels were determined by enzyme-linked immunosorbent assay in the first week after AMI in 50 patients. Catestatin levels reduced at admission and negatively correlated with heart rates; it increased significantly on the third day but remained decreased at 1 week and positively with blood pressure. In a subgroup of 20 patients admitted within 4?h after onset, circulating catestatin correlated inversely with norepinephrine. Catestatin might be involved in the course of AMI and act as a tool in monitoring the progression of AMI.     

Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump

Objective

To evaluate a 30-day and long-term outcome of patients with acute myocardial infarction (AMI) treated with intra-aortic balloon pump (IABP) counterpulsation and to identify predictors of a 30-day and long-term all-cause mortality.

Methods

Retrospective cohort study of 437 consecutive AMI patients treated with IABP between January 1990 and June 2004. A Cox proportional hazards model was used to identify predictors of a 30-day and long-term all-cause mortality.

Results

Mean age of the study population was 61 ± 11 years, 80% of the patients were male, and 68% had cardiogenic shock. Survival until IABP removal after successful haemodynamic stabilisation was 78% (n = 341). Cumulative 30-day survival was 68%. Median follow-up was 2.9 years (range, 6 months to 15 years). In patients who survived until IABP removal, cumulative 1-, 5-, and 10-year survival was 75%, 61%, and 39%, respectively. Independent predictors of higher long-term mortality were prior cerebrovascular accident (hazard ratio (HR), 1.8; 95% confidence interval (CI), 1.0–3.4), need for antiarrhythmic drugs (HR, 2.3; 95% CI, 1.5–3.3), and need for renal replacement therapy (HR, 2.3; 95% CI, 1.2–4.3). Independent predictors of lower long-term mortality were primary percutaneous coronary intervention (PCI; HR, 0.6; 95% CI, 0.4–1.0), failed thrombolysis with rescue PCI (HR, 0.5; 95% CI, 0.3–0.9), and coronary artery bypass grafting (HR, 0.3; 95% CI, 0.1–0.5).

Conclusions

Despite high in-hospital mortality in patients with AMI treated with IABP, a favourable number of patients survived in the long-term. These results underscore the value of aggressive haemodynamic support of patients throughout the acute phase of AMI.     

Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds

Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs.

Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission.

Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p?<?0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity.

Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.     

急性心肌梗死后血糖变化对预后的影响研究

目的：探讨急性心肌梗死后血糖变化对患者预后的影响。方法：对314例急性心肌梗死患者于入院后第2日早晨测空腹血糖值后,并进行回顾性对比分析。结果：随着血糖水平的逐渐升高,心力衰竭及心源性休克的发生率和病死率逐渐升高（P〈0.05）,严重心律失常的发生率逐渐升高,但差异无统计学意义（P〉0.05）。结论：急性心肌梗死患者伴应激性血糖升高者,随着血糖水平升高,其心力衰竭及心源性休克的发生率和病死率升高。血糖正常组预后明显好于血糖升高组。     

The gut microbiome and microbial metabolites in acute myocardial infarction

Emerging evidence has highlighted the role of gut microbiome in human health. However, the integrative role of gut microbiome and microbial metabolites in acute myocardial infarction (AMI) remains unclear. The current study profiles the microbial community through 16S rRNA gene sequencing and shotgun metagenomic sequencing and measures fecal short-chain fatty acids and circulating choline pathway metabolites among 117 new-onset AMI cases and 78 controls. Significant microbial alternations are observed in AMI patients compared with controls (P = 0.001). The abundances of nine species (e.g., Streptococcus salivarius and Klebsiella pneumoniae) are positively associated, and one species (Roseburia hominis) is inversely associated with AMI status and severity. A gut microbial score at disease onset is associated with the risk of major adverse cardiovascular events in 3.2 years (hazard ratio [95% CI]: 2.01 [1.04–4.24]) in AMI patients. The molar proportions of fecal acetate and butyrate are higher, and the circulating levels of choline and carnitine are lower in AMI patients than in controls. In addition, disease classifiers show that AMI cases and controls have a more distinct pattern in taxonomical composition than in pathways or metabolites. Our findings suggest that microbial composition and functional potentials are associated with AMI status and severity.     

心房颤动抗凝治疗的进展

心房颤动（简称房颤）是临床上常见的心律失常之一,是缺血性卒中的一个重要独立危险因素,房颤可使各年龄段脑卒中的危险增加4～5倍。因此,对于房颤患者,尤其是老年患者,无论是哪一型的房颤,均应进行抗凝治疗。近年来,房颤抗凝治疗取得了一定的成果,现概述如下。     

急性心肌梗死并发肺部感染患者的临床特点和病原菌特征及危险因素分析

分析急性心肌梗死（AMI）并发肺部感染患者的临床特点、病原菌特征及危险因素,为该类患者的治疗提供参考。

选择2019年1月至2021年1月海安市人民医院收治的96例AMI患者作为研究对象,并根据患者在治疗过程中是否并发肺部感染将其分为感染组（40例）和非感染组（56例）。采集患者痰液标本并对感染病原菌进行鉴定,同时观察肺部感染患者的临床特点。采用多因素Logistic回归分析探讨AMI患者并发肺部感染的危险因素。

96例AMI患者中存在40例肺部感染,共检出病原菌22株,其中革兰阴性菌14株（占63.64%）,革兰阳性6株（占27.27%）,真菌2株（占9.09%）。与非感染组比较,感染组患者血红蛋白、白蛋白、总蛋白水平较低,降钙素原、超敏C反应蛋白、肿瘤坏死因子-α水平较高（均P＜0.05）。单因素分析显示,AMI患者并发肺部感染与年龄、卧床时间、有无慢性阻塞性肺疾病、有无侵入性操作存在显著关联（均P＜0.05）。多因素Logistic回归分析显示,年龄≥60岁（OR = 3.71,95%CI：1.62～8.49）、卧床时间≥2周（OR = 3.42,95%CI：2.12～5.54）、慢性阻塞性肺疾病（OR = 2.68,95%CI：2.19～3.29）、侵入性操作（OR = 3.40,95%CI：2.69～4.30）及低蛋白血症（OR = 1.37,95%CI：1.09～1.74）均为AMI患者并发肺部感染的相关因素（均P＜0.05）。

AMI患者并发肺部感染的病原菌以革兰阴性菌为主,其次为革兰阳性菌;年龄、卧床时间、慢性阻塞性肺疾病、侵入性操作及低蛋白血症均为AMI患者并发肺部感染的独立危险因素。

     

急性心肌梗死后血糖变化对预后的影响研究

目的:探讨急性心肌梗死后血糖变化对患者预后的影响。方法:对314例急性心肌梗死患者于入院后第2日早晨测空腹血糖值后,并进行回顾性对比分析。结果:随着血糖水平的逐渐升高,心力衰竭及心源性休克的发生率和病死率逐渐升高(P<0.05),严重心律失常的发生率逐渐升高,但差异无统计学意义(P>0.05)。结论:急性心肌梗死患者伴应激性血糖升高者,随着血糖水平升高,其心力衰竭及心源性休克的发生率和病死率升高。血糖正常组预后明显好于血糖升高组。     

Dynamic changes in serum angiopoietin-1, angiopoietin-2, and angiopoietin-2/angiopoietin-1 ratio in acute myocardial infarction patients treated with primary percutaneous coronary intervention

Context: Angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) play divergent roles in myocardial ischemia and reperfusion injury.

Objective: To investigate serum Ang-1 and Ang-2 levels in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).

Methods: Serum Ang-1 and Ang-2 were measured in 85 STEMI patients in the first week after PCI.

Results: Ang-1, Ang-2 and Ang-2/Ang-1 ratio (Ang-2/1) were all increased at admission, and had dynamic changes after PCI. Ang-2 and Ang-2/1 at admission and 2 h after PCI were positively correlated with peak cardiac troponin T levels.

Conclusion: The extent of myocardial damage may be linked to circulating Ang-2 and Ang-2/1.     

Thrombolysis with tissue plasminogen activator in patients with acute myocardial infarction

Thrombolytic agents are being employed clinically in increasing numbers of patients in the attempt to eliminate occlusive coronary thrombi in patients with evolving myocardial infarction. When administered by the intracoronary route, streptokinase lyses is successful in coronary thrombi in more than two-thirds of patients, but when administered intravenously is successful in only one-third. Since streptokinase is a nonselective plasminogen activator, it induces fibrinogenolysis when administered selectively or systematically with an attendant marked reduction in plasma fibrinogen levels and significant bleeding complications. In contrast, the action of tissue plasminogen activator (t-Pa) is relatively selective for fibrinolysis (as opposed to fibrinogenolysis). It induces coronary thrombolysis in at least 60% of patients when administered either into a coronary ostium or a peripheral vein without producing substantial reductions in circulating fibrinogen. Bleeding complications are modest and usually related to high administered doses and concomitant heparinization, and occur primarily at sites of vascular access. Thus, t-Pa appears to be a promising agent for thrombolytic treatment of patients with evolving acute myocardial infarction.     

Role of B lymphocytes in the infarcted mass in patients with acute myocardial infarction

Despite early reperfusion, patients with ST segment elevation myocardial infarction (STEMI) may present large myocardial necrosis and significant impairment of ventricular function. The present study aimed to evaluate the role of subtypes of B lymphocytes and related cytokines in the infarcted mass and left ventricular ejection fraction obtained by cardiac magnetic resonance imaging performed after 30 days of STEMI. This prospective study included 120 subjects with STEMI submitted to pharmacoinvasive strategy. Blood samples were collected in subjects in the first (D1) and 30th (D30) days post STEMI. The amount of CD11b+ B1 lymphocytes (cells/ml) at D1 were related to the infarcted mass (rho = 0.43; P=0.033), measured by cardiac MRI at D30. These B1 cells were associated with CD4+ T lymphocytes at D1 and D30, while B2 classic lymphocytes at day 30 were related to left ventricular ejection fraction (LVEF). Higher titers of circulating IL-4 and IL-10 were observed at D30 versus D1 (P=0.013 and P<0.001, respectively). Titers of IL-6 at D1 were associated with infarcted mass (rho = 0.41, P<0.001) and inversely related to LVEF (rho = −0.38, P<0.001). After multiple linear regression analysis, high-sensitivity troponin T and IL-6 collected at day 1 were independent predictors of infarcted mass and, at day 30, only HDL-C. Regarding LVEF, high-sensitivity troponin T and high-sensitivity C-reactive protein were independent predictors at day 1, and B2 classic lymphocytes, at day 30. In subjects with STEMI, despite early reperfusion, the amount of infarcted mass and ventricular performance were related to inflammatory responses triggered by circulating B lymphocytes.