8 Cardiovascular System

8 Cardiovascular System

2015178 Prognostic efficacy of combined index of cardiac biomarkers for cardiovascular and all-cause mortality on hemodialysis patients.ZHANG Lihong（張麗紅），et al.Renal Dept，Beijing Haidian Hosp，3rd Hosp，Peking Univ，Beijing 100080.Chin J Nephrol 2015；31（3）：173-178.

Objective To evaluate cardiac biomarkers as biological risk factors for cardiovascular and all-cause motality in HD patients.In addition，a multimarker approach including inflammatory index was performed to improve the cardiovascular and all-cause risk assessment of these patients.MethodsTheauthormeasuredTroponin-T （TnT），N-terminal pro brain natriuretic peptide（NT-proBNP）andhigh-sensitivityC-reactiveprotein （HsCRP），collected the clinical data at baseline（January 2012）in 229 HD patients in three hemodialysis centers in Haidian District of Beijing，recorded time and cause of death in the next 1000 days.Kaplan-Meier was used to calculate survival rate and impact factors of prognosis.Cox proportional hazard model was used to estimate significance of TnT，NT-proBNP and HsCRP and adjusted hazard ratios（HRs）of death.Results During the follow-up，37 patients died，mainly from cardiac cause（54.05%，20/37）.Univariate analysis found old age，diabetes，cardiovascular disease，low serum albumin，CRP≥3 mg/L，TnT≥0.1 mg/L，NT-proBNP≥4381 ng/L were associated with prognosis.Elevated cT-nT，NT-proBNP or HsCRP were all associated with increased cardiovascular and all-cause motality.Moreover，the combination of all parameters（NT-proBNP≥4381 ng/L and TnT≥0.1 mg/L and HsCRP≥3 mg/L）were dramatically associatedwithincreasedcardiovascular cause mortality（HR=25.25，P＜0.01）and all-cause mortality（HR=27.33，P＜0.01）.The associations were significant even after full adjustment f or cardiovas-cular（HR=14.33，P＜0.01）and all-cause mortality （HR=11.54，P＜0.01）respectively.Conclusion A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for cardiovascular mortality and all-cause mortality，strongly supporting the annual routine determination of these biomarkers.

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2015179 Differential expression of microRNAs in aortic tissue and plasma in patients with acute aortic dissection.WANG Xiaojian（王曉建），et al.State Key Lab，Cardiovasc Dis，Cardiovasc Instit&Fuwai Hosp，CAMS&PUMC，Beijing 100037.Chin Cir J 2015；30 （2）：154-158.

Objective We want to identify the new microRNAs （miRNAs）biomarker for diagnosing the patients with acute aoritc dissection（AAD）.Methods Our work included 2 sets of groups.①AAD 1 tissue group，containing the aortic tissue of A type AAD patients and Control 1 group，containing the aortic tissue of the subjects without cardiovascular disease，4 in each group.②AAD 2 plasma group，containing the plasma of A type AAD patients and Control 2 group，containing the plasma of the subjects without cardiovascular disease，20 in each group.The age and gender were strictly matched between the patients and control subjects.The miRNAs expression in ascending aortic tissue and plasma were examined by microarray analysis in 4 groups，and the results in 2 sets of groups were integrated to identify the differential expression of miRNAs in AAD patients.Results The microarray analysis indicated that in AAD patients，the aortic tissue had 30 differentially expressed miRNAs，13 of them were up-regulated and 17 were down-regulated；plasma had 93 differentially expressed miRNAs，33 of them were up-regulated and 60 were down-regulated. With integrated analysis，4 miRNAs expressions were increased in both aortic tissue and plasma as miR-4313，miR-933，miR-1281 and miR-1238.Compared with Control 1 group and Control 2 group，AAD 1 group and AAD 2 group showed up-regulated miR-4313 at 1.5-fold and 42.4-fold，up-regulated miR-933 at 10.4-fold and 26.8-fold，up-regulated miR-1281 at 1.7-fold and 17.8-fold，up-regulated miR-1238 at 1.3-fold and 13.8-fold respectively.Conclusion There were 4 differentially expressed miRNAs in both aortic tissue and plasma in AAD patients，which might be the potential biomarkers of AAD，while large sample investigation is needed.

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2015180 Relationship between helicobacter pylori infection and inflammatory cytokines，homocysteine in patients with coronary artery disease.SHEN Yunfeng（沈云峰），et al.Dept Clin Lab，Wuhan No.6 Hosp，Wuhan 430015.Chin Cir J 2015；30（2）：119-122.

Objective To study the relationship between helicobacter pylori（HP）infection and inflammatory cytokines，homocysteine（Hcy）in patients with coronary artery disease（CAD），and the relationship between cytotoxin associated protein A toxins of HP（HPCagA）and CAD occurrence.Methods Our research included 2 groups：CAD group，n=105 and Control group，n=76，patients without CAD.The serum Hp-IgG antibody and HpCagAIgG antibody were measured by ELISA.Blood levels of Hs-CRP，TNF-α，IL-6 and Hcy were examined and compared between 2 groups.The differences between CAD patients with HP infection and without HP infection were compared，and the differences between CAD patients with positive HPCagA-IgG and negative HPCagAIgG were compared.Logistic regression analysis was conducted to study the risk factors of CAD，the adjusted OR and 95%CI were used to evaluate the positive Hp for CAD risk.Results The positive rate of HP-IgG in CAD group and Control group were 52.3%and 35.5%；compared with Control group，CAD group had the increased levels of Hs-CRP，TNF-α，IL-6 and Hcy；in CAD group，the patients with positive HP-IgG showed the higher levels of Hs-CRP，TNF-α，IL-6 and Hcy than those with negative HP-IgG，and the patients with positive HpCagA-IgG presented the higher levels of Hs-CRP，TNF-α，IL-6 and Hcy than those with negative HPCagAIgA，all P＜0.05.Logistic regression analysis indicated that with adjusted traditional risk factors， the positiveHP-IgG and positive HpCagA-IgG were the risk factors for CAD（OR=2.278，95%CI：1.20-4.32，P= 0.012 and OR=3.297，95%CI 1.50-7.27，P= 0.03）.Conclusion HP infection might be related to CAD，and the patients with HP infection and positive HPCagA-IgG could have CAD occurrence and development.

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2015181 Clinical research for the relationship between plasma homocysteine and atherosclerosis，left ventricular hypertrophy in patients with essential hypertension.CAO Liping（曹立平），et al.Dept Cardiol，1st People's Hosp，Anqing 246003.Chin Cir J 2015；30（2）：133-135.

Objective To study the plasma level of homocysteine（Hcy）and atherosclerosis，left ventricular hypertrophy in patients with essential hypertension（EH）.Methods A total of 384 EH patients were divided into 3 groups：GradeⅠ group，n=82，GradeⅡ group，n= 196 and GradeⅢgroup，n=106.There was a Control group containing 79 healthy subjects.Plasma levels of Hcy，carotid artery intima-media thickness and plaque condition were examined and compared among different groups.According to echocardiography，the EH patients were further divided into 2 groups：With left ventricular hypertrophy group，n=258 and without left ventricular hypertrophy group，n=126.The plasma Hcy level was compared between 2 groups.Results The plasma Hcy level and arotid artery intima-media thickness were different between Control group and EH patients，P＜0.001.With the increased severity of hypertension，the Hcy level and arotid artery intima-media thickness were elevated accordingly，and the carotid artery plaques in GradeⅡgroup and GradeⅢgroup were more than that in GradeⅠ group，all P＜0.001.The Hcy level in group with left ventricular hypertrophy was higher than that in that group without left ventricular hypertrophy，P＜0.001.Conclusion Plasma Hcy is closely related to EH occurrence and development.Hcy level may reflect the severity of atherosclerosis and left ventricular hypertrophy in EH patients.

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2015182 Risk factor comparison for different level of insulin resistance in patients with coronary artery disease during hospitalization.CHU Xinmei（楚新梅），et al.Dept Cardiol，Beijing Haidian Hosp，Peking Univ，Beijing 100080.Chin Cir J 2015；30（2）：116-118.

Objective To ccmparatively analyze the multiple risk factor distribution for different level of insulin resistance（HOMA IR）in patients with coronary artery disease （CAD）.Methods A total of 203 in-hospital patients were divided into 2 groups，CAD group，n=132 and Control group，n=71.According to the quartile value of HOMA IR，the patients in Control group were further divided as following：25thpercentile（1.53），50thpercentile （3.46）and 75thpercentile（5.14）.The patients in CAD group were further divided into 4 sub-groups：①HOMA IR≤1.53，n=28，②HOMA IR：1.54-3.46，n=25，③HOMA IR：3.47-5.13，n=28 and④HOMA IR≥5.14，n=51.Multiple risk factors of insulin resistance in CAD patients were studied by Homeostasis model assessment.Results In CAD group，the weight，waist-tohip ratio（WHR），waist circumference，LDL-C，fasting glucose，2h glucose and fasting insulin level were increased in Sub-group④ than Sub-group①；the fasting TC，LDL-C，fasting glucose，2h glucose and fasting insulin level were increased in Sub-group④ than Subgroup②，P＜0.05-0.01.Conclusion The elevated weight，WHR and LDL-C level were the major features of insulin resistance in CAD patients at the area.

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2015183 The relationship between indoxyl sulfate and left ventricular hypertrophy in hemodialysis patients.CAO Xuesen（曹學森），et al.Dept Nephrol，Shanghai Kidney&Dialysis Instit，F(xiàn)udan Univ，Shanghai 200032.Chin J Nephrol 2015；31（3）：186-194.

Objective To investigate the relationship between indoxyl sulfate（IS）and left ventricular hypertrophy （LVH）in hemodialysis patients.Methods For the eligible patients（age≥18 years，dialysis duration＞6 months，without history of congestive heart failure within 3 months and comorbidity of cardiac aneurysm），clinicaldata were collected，biochemical measurements were completed，and echocardiographic examinations were performed.Plasma IS concentration was determined by high performance liquid chromatography electrospray tandem spectrometry（HPLC-ESI-MS/MS）.Linear and Logistic regression models were employed to assess the associations of plasma IS and left ventricular mass index （LVMI）and LVH，respectively.Results Two hundred and ten hemodialysis patients（117 males）with mean age of（57.2±14.3）years were enrolled.The prevalence of LVH was up to 64.0%.Univariate linear regression showed that plasma IS was positively correlated with LVMI（β=7.09，P=0.02）.The result persisted after adjustment for all kinds of risk factors（β=4.16，P= 0.03）.Patients were categorized into two groups：LVH and non-LVH group.Logistic regression models were employed to assess the relationship of plasma IS and LVH.The result showed that plasma IS was independently associated with LVH after adjustment for other confounding risk factors（β=6.54，OR=1.13，95%CI 1.09-1.44，P=0.03）.Conclusion LVH is prevalent in hemodialysis patients.Plasma IS is significantly correlated with LVMI and the independent risk factor for LVH.

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2015184 Effects of target blood glucose control with insulin therapy on systolic and diastolic cardiac function in septic patients.JIANG Xiaoxia（姜曉霞），et al.1st Affil Hosp，Med Coll，Shihezi Univ，Shihezi 832000.Natl Med J China 2015；95（9）：663-667.

Objective To explore the protective effects of target blood glucose control on cardiac dysfunction in septic patients.Methods For this prospective and randomized interventional study，a total of 90 septic patients were divided into group A（blood glucose levels of 4.4 to 6.1 mmol/L），group B（6.1 to 8.3 mmol/L）and group C （8.3 to 10.0 mmol/L）（n=30 each）.And 30 non-septic subjects were selected into control group.Serial transthoracic echocardiogram（TTEs）was performed to measure left ventricle ejection fraction（LVEF）and ratio of blood flow velocity of mitral annulus during early diastole（E）and atrial contraction（A）before and 1，3，7 days after blood glucose control with insulin therapy.The plasma level of brain natriuretic peptide（BNP）was detected by enzyme-linked immunosorbent assay（ELISA）. The patient records were reviewed to obtain information about demographics，AcutePhysiologyandChronic Health EvaluationⅡ（APACHEⅡ）scores，incidence of hypoglycemia and 28-days survival rates.Results No significant inter-group improvement existed in mean values of LVEFs（P=0.184）.And E/As differed among the groups and there was statistical difference between groups A and C（P=0.005）.There was an increasing trend for the levels of BNP of groups A，B and C.And comparison of group A with group B/C had statistical variability（PAB=0.028，PAC=0.000）.LVEFs had no variation（P1=0.310，P3=0.174）while E/A and BNP were significantly higher or lower in group A than those in others at Day 1 and 3（P=0.005）.The LVEFs were similar at Day 7 and E/As and BNPs of groups A，B and C showed statistical differences.The variation of E/As with time differed between groups A，B and C.Conclusion Maintaining a target blood glucose of 4.4 to 6.1 mmol/L may improve cardiac dysfunction.Furthermore，it has more significant improvement of diastolic dysfunction than systolic counterpart.Combined utilization of LVEF，E/A and BNP is better in evaluating critical ill patients with sepsis-induced cardiomyopathy under target blood glucose control.It suggests that a glucose level of 4.4 to 6.1 mmol/L may benefit cardiac consistent dysfunction in septic patients during 7 days after treatment.

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2015185 A prospective study on the association of plasma homocysteine level with stroke in hypertensive patients.MA Jianping（馬劍平），et al.Shenzhen Nanshan Chronic Dis Contr Center，Shenzhen 518054. Chin J Intern Med 2015；54（4）：296-301.

Objective To analyze the association between homocysteine（Hcy）and stroke in hypertensive patients. Methods This was a prospective cohort study conducted in 60 communities in Nanshan District，Shenzhen.Totally 5 488 patients with hypertension were inclu ded atbaseline survey and followed for an average of 2.7 years. At the end of follow-up，327（5.96%）subjects were missing with unknown reasons.Hcy was detected by enzymatic cycling method.Head CT，MRI，cerbral angiography and transcranial Doppler ultrasound were performed in the patients.Stroke was defined based on the International Classification of Disease（ICD10 coding I60-I64）.Results After an average of 2.7-year follow-up，197 developed new stroke.The incidence rate was 3.82%.Subjects whose Hcy levels were within the highest quartile（Q4）had higher risk to develop stroke compared with those whose Hey levels were within the lowest quartile（Q1）.The HR（95%CI）was 7.4（3.2-13.2）in total with 7.5（3.0-19.5）in men and 7.7（2.7-22.1）in women after adjustment of age，sex，education，smoking，alcohol drinking，and BMI，physical activity，diabetes，depression，family history of stroke or coronary heart disease，years of hypertension，antihypertensive drugs，folic acid，systolic blood pressure，TC，glucose had TG.For every 5 μmol/L increase in Hcy，the HR（95%CI）of stroke increased 1.15-fold（1.09-1.21）in total subjects with 1.15（1.08-1.21）in men and 1.19（1.04-1.35）in women，respectively.No significant interactions on stroke could be found between Hcy and the above stratified factors.Conclusion Elevated Hcy levels were associated the stroke in hypertensive patients.

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2015186 Role of NF-κB/survivin signal pathway on intima hyperplasia of rat carotid balloon injury restenosis model.CHENG Wei（成威），et al.Dept Cardiol，Jingmen 1st People's Hosp，Jingmen 448000.Chin J Cardiol 2015；43（3）：248-253.

Objective To investigate the role of NF-κB/survivin signal pathway in the intima hyperplasia of rat carotid balloon injury restenosis model.Methods NF-κB siRNA lentivirus vector（titer was 1×108TU/ml）was established.Carotid balloon injury restenosis model was made in 33 SD rats.The rats were divided into 4 groups according to different processing methods，including negative control（NC）group（n=11），NF-κB siRNA group（n=11），NF-κB siRNA+YM155（survivin inhibitor）（n=11），the uninjured carotid artery served as the normal control group（n=11）.After 7 days，the carotid samples（n=5 each group）were harvested to detect the NF-κB and survivin mRNA expression by RT-PCR.The carotid sample were harvested on 28 days（n=6 each group）for HE staining and measuring intima hyperplasia. Immunohistochemical method was also used to detect the expression of intima proliferation cell nuclear antigen （PCNA）and media α-SM-actin.Results（1）After 7 days，NF-κB and survivin mRNA expression was significant higher in NC group than in normal control group （P＜0.05），the NF-κB mRNA expression was significantly lower in NF-kB siRNA group than in NC group （P＜0.05）and similar between NF-κB siRNA group and NF-κB siRNA+YM155 group.The survivin mRNA expression was significantly lower in NF-κB siRNA group compared to NC group（P＜0.05）and significantly higher in NF-κB siRNA group than in NF-κB siRNA+ YM155 group（P＜0.05）.（2）After 28 days，intima hyperplasia was observed in NC（0.13±0.01），NF-κB siRNA（0.11±0.01）and NF-κB siRNA+YM155 group （0.09±0.01）mm2（P＜0.05）.Media area was similar among NC group，NF-κB siRNA group and NF-κB siRNA+YM155 group（P＞0.05）.I/M ratio was gradually reduced among NC group（1.55±0.07），NF-κB siRNA group（0.92±0.08），NF-κB siRNA+YM155 group （0.76±0.06，all P＜0.05）.Similar results were found in the residual restenosis rate：NC group（58.71± 0.02）%，NF-κB siRNA group（32.13±0.05）%，NF-κB siRNA+YM155 group（26.42±0.03）%（all P＜0.05）and expression of vascular smooth muscle cell PCNA：NC group（45.32±7.21）%，NF-κB siRNA group （36.54±6.42）%，NF-κB siRNA+YM155 group （28.57±6.31）%（all P＜0.05）.On the contrary，the IOD of α-SM-actin in media increased gradually：NC group（0.55±0.006），NF-κB siRNA group（0.072± 0.011），NF-κB siRNA+YM155 group（0.084± 0.008，all P＜0.05）.Conclusion Inhibiting NF-κB expression can significant decrease intima hyperplasia in this model，and this effect may be mediated by inhibiting survivin and reducing the proliferation of va scular smoothmuscle cells.

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2015187 Prevalence and echocardiographic feature of bicuspid aortic valve in patients with severe aortic stenosis：a echocardiography database analysis.PAN Wenzhi（潘文志），et al.Dept Cardiol，Zhongshan Hosp，F(xiàn)udan Univ，Shanghai 200032.Chin J Cardiol 2015；43（3）：244-247.

Objective To evaluate the accuracy of echocardiography in identifying aortic valve structures and determine the prevalence of bicuspid aortic valves（BAV）in severe aortic stenosis（AS）population to provide useful informationfortranscatheteraorticvalvereplacement （TAVR）.Methods A total of 300 AS patients undergoing surgical aortic valve replacement were included to determine the accuracy of transthoracic echocardiography in identifying BAV from January 2009 to July 2013.The echocardiographic data of our hospital from 2004 to 2012 was retrospectively reviewed.1 371 patients with isolated severe native aortic valves stenosis were consecutively enrolled.Results The aortic valve structures could be defined by transthoracic echocardiography in 75.7%（227/ 300）patients with severe AS.With BAV diagnosis during operation as gold standard，the accuracy of transthoracic echocardiography in identifying BAV was 89.4% （203/227）.Among 1 371 patients with severe AS，the percentage of BAV in patients aged＜40 years，aged 40-59 years，aged 60-69 years，aged 70-79 years and aged≥80 years was 60.0%（57/95），57.5%（262/ 456），42.7%（184/431），43.2%（133/308）and 21.0%（17/81），respectively.Incidence of BAV in patients with degenerative calcific valve was significant higherthaninthosewithrheumaticheartdisease ［44.3%（552/1 246）vs.4.0%（3/76），P＜0.01］. Proportion of combined aortic regurgitation≥grade 2 was significantly lower，ascending aortic diameter was larger and left ventricular end-diastolic dimension was smaller in BAV patients compared to severe AS patients with tricuspid valves（all P＜0.01），while aortic valve annuals diameter and accompanying cardiovascular diseases between BAV and tricuspid aortic valve groups were similar（all P＞0.05）.Conclusion Transthoracic echocardiography could accurately identify aortic valve structures in about 76%patients.BAV is common in severe AS patients in all ages.These results provide important information for the popularization of TVAR.

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2015188 Current status and influence factors of beta blocker prescription in Chinese patients with stable angina pectoris.JIANG Jie（蔣捷），et al.Dept Cardiol，Peking Univ 1st Hosp，Beijing 100034.Chin J Cardiol 2015；43（3）：227-233.

Objective To analyze the status of beta blockers （BBs）prescriptionin Chinese patients with stable angina pectoris.To determine the gap between clinical practice and treatment guidelines and factors influencing the use of BBs in Chinese patients.Methods A questionnaire survey was conducted in patients diagnosed with chronic stable angina pectoris in 2011.A total of 298 Chinese hospitals attended the survey.The questionnaire collected patient demographic information，clinical and medication information.In the analysis，patients were divided into two groups according to whether they were on BBs at the time of the interview.Hospital characteristics，patient demographic information，cardiovascular risk factors，diagnostic method of coronary heart disease，past history of coronary revascularization and use of secondary prevention medications were compared between the two groups.Binary logistic regression analysis was used to identify factors related to BBs use.Patients were followedup for 3 months.Patients who were on BBs at baseline were divided into two groups according to whether they were still on BBs after 3 months.Comparison of the clinical information previously mentioned was made between the two groups，and binary logistic regression analysis was used to identify factors related to BBs adherence. Results Of the 5 011 questionnaires，2 859 cases were male，mean age was（67.6±11.5）years old，and 3 060（61.1%）patients were on BBs at baseline.Binary logistic regression analysis showed that when adjusted for other factors，old age（OR=0.895，95%CI 0.849-0.944，P＜0.001）was related to no BBs use， while co-morbidity with hypertension（OR=1.255，95%CI 1.103-1.427，P=0.001）or hyperlipidemia（OR= 1.456，95%CI 1.287-1.648，P＜0.001），diagnosed with coronary disease by imaging（OR=1.250，95%CI 1.070-1.461，P=0.005）and past history of coronary revascularization（OR=1.490，95%CI 1.220-1.820，P＜0.001）were related to higher percentage of BBs use.A total of 2 533 cases（82.8%）were still taking BBs 3 months after baseline interview.Binary logistic regression analysis showed that，when adjusted for other factors，treated at traditional Chinese medical hospitals （OR=1.612，95%CI 1.154-2.251，P=0.005），low levels of education（OR=1.316，95%CI 1.151-1.504，P＜0.001），hypertension（OR=1.345，95% CI 1.096-1.651，P=0.005），high baseline heart rate （OR=1.342，95%CI 1.095-1.644，P=0.005）were factors related to higher BBs adherence，while low baseline CCS class（OR=0.794，95%CI 0.704-0.896，P＜0.001）was related to lower BBs adherence. Conclusion In Chinese patients with clinically diagnosed chronic stable angina，BBs use was not sufficient.Old age，comorbidity with hypertension or hyperlipidemia，past history of coronary revascularization were independently related to higher percentage of BBs use.Treated at traditional Chinese medical hospitals，low levels of education，hypertension，high baseline heart rate and coronary disease diagnosed by imaging were independent factors related to higher BBs adherence，while low baseline CCS class was related to lower adherence.

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2015189 Impact of transfection with recombinant adenovirus vector-mediated Klotho gene on myocardial remodeling in a rat model of heart failure.JIA Zheng（賈政），et al.Graduate Coll，Guilin Med Univ，Guilin 541004.Chin J Cardiol 2015；43（3）：219-226.

Objective To assess the impact of transfection with recombinant adenovirus vector-mediated Klotho gene on myocardial remodeling in a rat model of heart failure （HF）by intraperitoneal injectionof isoproterenol. Methods Rats were divided into 5 groups by table of exponential random numbers：normal control group，HF group，saline-control HF group，recombinant adenovirus vector transfection group（Ad.EGFP group，2×1010pfu，0.5 ml/rat），pDC316-CMV-EGFP-rKlotho transfection group（Ad.Klotho group，n=5 each）.Left ventricular ejection fraction（LVEF）was obtained by echocardiography，hemodynamicparametersobtainedby multi-channel physiological recorder，myocardial tissue underwent pathohistological examination.Additionally，the green fluorescin expression was observed on frozen heart section.Myocardial fibrosis correlated gene expression including Klotho gene，collagenⅠ andⅢwas detected by real time-PCR.Moreover，plasma levels of B-type natriuretic peptide（BNP）were measured with ELISA.Results Compared to saline control HF group，LVEF，LVSP and±dp/dtmax were significantly increased，myocardial fibrosis and myocardial remodeling were significantly attenuated in the Ad.Klotho group and there was green fluorescin distribution in myocardial tissues of Ad.Klotho group.Klotho expression was downregulated and collagenⅠandⅢexpression was upregulated in HF rats compared to normal control group（all P＜0.05）and these changes could be significantly reversed in Ad.Klotho group（all P＜0.05）.Plasma BNP level was also significantly lower in Ad.Klotho group than in HF group（P＜0.05）.Conclusion Klotho gene transfection could improve cardiac function and attenuate cardiac remodeling and reducing myocardial fibrosis.

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2015190 2-Methylthio-adenosine-5′-triphosphate inhibits ventricular arrhythmogenesis in rabbits with chronic heart failure.YANG Yi（楊溢），et al.Dept Gerontol，Guangdong Prov Corps Hosp，Chin People's Armed Forces，Guangzhou 510507.Chin J Cardiol 2015；43（3）：212-218.

Objective To investigate the effects and related mechanismsof2-methylthio-adenosine-5′-triphosphate （2-MeSATP），an important extracellular agonist that activates receptors for purine nucleotides（P2XR），on ventricular arrhythmias in rabbits with chronic heart failure （CHF）.Methods The male New Zealand rabbits were divided into control（n=12），CHF（n=12） and CHF+2-MeSATP groups（2-MeSATP，n=12）.CHF was induced by isoproterenol injection（0.3 mg·kg-1·d-1for 3 weeks）and rabbits were observed 6 months later.The main cardioelectrophysiological parameters and ventricular arrhythmias were tested by recording monophasic action potential（MAP）with burst-pacing（BCL）in rabbits in vivo.The transient outward potassium current（Ito）was recorded via whole-cell patch clamp technique and the fluorescence intensity of intracellular free Ca2+was detected with Flup-3/AM loading by the laser scanning confocal microscope in enzymatically dissociated single rabbit ventricular myocytes.Results CHF rabbits developed severely clinical CHF signs and symptoms，reduced left ventricular ejection fraction and fractional shortening as well as enlarged end-diastolic dimension.Compared with CHF group，APA and MaxdV/dtwere significantly increased，while APD20，APD50and APD90were significantly reduced in 2-MeSATP group（all P＜0.01）.Moreover，2-MeSATP could obviously shorten BCL induced ventricular arrhythmias，and decrease deducibility and persistence time of ventricular arrhythmias with burst-pacing in 2-MeSATP group in vivo（all P＜0.05）.With voltage clamp model，2-MeSATP could significantly increase the current density of Itoin different command potential in CHF ventricular myocytes（all P＜0.01）. When holding potential was set at-50 mV and command potential was set at+50 mV，the current densities of Itoincrease was more significant in 2-MeSATP group than that in CHF group［（11.79±4.51）pA/pF vs. （7.94±3.53）pA/pF，P＜0.01］.2-MeSATP could completely change the I-V curve upward without changing the I-V curve direction in CHF ventricular myocytes.The fluorescence intensities of intracellular free Ca2+increase was more significant in 2-MeSATP group compared to CHF group［（1 291.98±123.31）μmol/L vs.（793.59±114.65）μmol/L，P＜0.01］.Conclusion 2-MeSATP as a potent agonist acting on P2XR could significantly shorten APD，increase heart rate and improve cardiac performance as well as decrease the susceptibility of ventricular arrhythmias in this rabbit CHF model.Our results suggest that Itoincrease and sarcoplasmic reticulum uptake Ca2+enhancement as well as dynamic balance of intracellular Ca2+cycling sustenance might linked to the beneficial effects of 2-MeSATP in this CHF model.

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2015191 Peak oxygen consumption，NT-proBNP and echocardiographic changes in patients with chronic heart failure.LU Zhinan（盧志南），et al.State Key Lab Cardiovasc Dis，F(xiàn)uwai Hosp，Natl Cardiovasc Dis Center，CAMS&PUMC，Beijing 100037.Chin J Cardiol 2015；43（3）：206-211.

Objective To assess peak oxygen consumption（peak VO2）derived from cardiopulmonary exercise testing （CPET），concentrations of NT-proBNP and echocardiographic changes in patients with chronic heart failure （CHF）and reduced left ventricular ejection fraction （LVEF，＜40%）.Methods Seventy patients were included and divided into two groups according to the New York Heart Association（NYHA）classification：NYHAⅡgroup（17 cases）and NYHAⅢ-Ⅳgroup（53 cases）. The basic clinical information，plasma concentration of NT-proBNP at rest，echocardiographic parameters and peak VO2from CPET were compared between two groups.Correlation among peak VO2，NT-proBNP and echocardiographic parameters in this patient cohort was assessed and their abilities to discriminate the NYHAⅢ-Ⅳ grade were analyzed through c-Statistic.Results Left atrial diameter［（51.3±7.2）mm vs.（44.0± 7.4）mm，P＜0.001］was larger，plasma concentration of NT-proBNP（1 379-4 399 pmol/L vs.1 109-2 356 pmol/L，P＜0.01）was higher and peak VO2［（13.4± 3.5）ml·kg-1·min-1vs.（18.2±3.7）ml·kg-1· min-1，P＜0.001］were significantly lower in NYHAⅢ-Ⅳgroup than those in NYHAⅡ group.However，left ventricular end-diastolic diameter（LVEDD）and LVEF were similar between two groups.Peak VO2correlated significantly with NT-proBNP（r=-0.311，P＜0.01），but neither peak VO2nor NT-proBNP correlated significantly with echocardiographic parameters（LA，LVEDD and LVEF）.ROC analysis showed that peak VO2had the strongest discriminatory power for detecting NYHAⅢ-Ⅳgrade patients（AUC=0.835，P＜0.001），fol-lowed by the NT-proBNP（AUC=0.723，P＜0.01）. Conclusion Peak VO2is a more sensitive parameter to detect the disease aggravation（NYHAⅢ-Ⅳgrade）of the CHF patients with reduced LVEF compared to plasma NT-proBNPandechocardiographicparameters（LA，LVEDD，LVEF）.

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2015192 Comparative study in clinical features and management of aortic dissection between Chinese and Caucasians.SHEN Shikai（沈世凱），et al.Dept Vascular Surg，1st Hosp，China Med Univ，Shenyang 110001.Natl Med J China 2015；95（10）：776-780.

Objective To explore differences in the clinical characteristics，treatment methods and prognosis of Chinese（Han）and Western populations（Caucasia）aortic dissection（aortic dissection，AD）patients.Methods According to the requirements of systematic review，we searched MEDLINE（1980-2014），Emabse（1980-2014），CBM（1980-2014）and CNKI（1980-2014）database overall，themeta-analyseswereperformed through STATA 12.0.Results A total of 6 697 Stanford A AD and 3 381 Stanford B AD Caucasian patients and 850 Standford A AD and 4 745 Stanford B AD Chinese Han patients were deemed eligible.It showed that average age of Han patients was lower，the proportion of Han group was 84.5%，while Cuacasian group was 66.9%，the differences were statistically significant（χ2=365.37，P＜0.01）.Han patients with history of smoking and that of coronary heart disease accounted for 53.0%，13.8% separately，which were higher than those of Caucasian group，the differences were also statistically significant （χ2=264.23，68.417，P＜0.01）.Besides these，the proportions of Han Stanford B AD patients who had hypertension，diabetes were also statistically significant higher than Caucasian group（χ2=264.23，68.417，P＜0.01）.The Chinese group was more likely to appear nervous system and heart damages before surgery while the Caucasian group mostly appeared kidney and peripheral vascular damages.In the choice of treatment，the number of open surgery patients was significantly higher than that in Caucasian group.Domestic acute AD patients were more likely to accept TEVAR.The 30-day mortality of Chinese Han group in Stanford B was 2.4%，while Caucasians'mortality was 11.2%，the differences were statistically significant（χ2=142.96，P＜0.01）. Conclusion The incidence of Chinese AD patients who are younger with more basic diseases has been increasing gradually.Although the 30-day mortality and complications rates of Chinese patients accepting early surgery intervention are lower than Caucasians，and due to the less available data，large sample researches and further longterm follow-up should be needed.

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2015193 Effect of obesity on blood pressure variation and plasma levels of nitric oxide and endothelin in elderly hypertensive patients.WU Zebing（吳澤兵），et al.Dept Geriatr，3rd Affil Hosp，Anhui Med Univ，1st People's Hosp，Hefei 230061.Chin J Geriatr 2015；34（4）：369-373.

Objective To investigate the effects of obesity on blood pressure variation and plasma levels of nitric oxide （NO）and endothelin（ET）in elderly hypertensive patients.Methods A total of 175 elderly patients with hypertension were screened for this study.Based on body mass index，they were categorized into three groups with normal weight（n=69），overweight（n=56）and obesity （n=50）.24-hour dynamic blood pressure，NO and ET levels were nonitored.Results No significant differences in 24 h systolic blood pressure，daytime systolic blood pressure，night time systolic blood pressure，24-hour diastolic blood pressure（24 h-DBP）and night-time diastolic blood pressures were found among the groups（all P＞0.05）.Morning systolic and diastolic blood pressures were higher in obese group than in normal weight and overweight groups（both P＜0.05）.The daytime diastolic blood pressure was higher in obese group than in overweight group.24 h systolic blood pressure variation，daytime systolic blood pressure variation，and blood pressure pattern were higher in obese group than in overweight and normal weight group［（12.6±2.7）%vs. （10.4±2.2）%and（9.4±1.9）%，（12.2±2.9）% vs.（10.2±2.2）%and（9.2±2.1）%，（5.2±10.5）%vs.（1.4±6.9）%and（1.8±8.2）%group，all P＜0.05］.The night time systolic blood pressure variation，24 h diastolic blood pressure variation，daytime diastolic blood pressure variation were increased in obese group as compared with normal weight group［（9.8± 3.7）%vs.（8.2±3.1）%，（15.3±3.3）%vs. （13.2±4.2）%，（14.7±3.7）%vs.（12.9±3.8）%，all P＜0.05］.No differences were found in night time diastolic blood pressure variation among the groups. Plasma NO level was lower in obese group than in overweight and normal weight group［（29.8±14.2）μmol/L vs.（47.9±18.6）μmol/L and（94.6±42.9）μmol/ L，P＜0.01］.Plasma ET level was significantly higher in obese group than in overweight group and normal weight group［（46.5±9.8）ng/L vs.（37.3±4.8）ng/ L and（31.1±5.5）ng/L，P＜0.01］.24 h systolic blood pressure variation was significantly correlated with plasma NO level（r=0.340，P=0.004）in normal weight group.Conclusion Obesity can effectively increase blood pressure variation and ET level，and reduce plasma NO level in elderly hypertensive patients.Obesity is one of the most important influencing factors for blood pressure variation，plasma NO and ET levels.

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2015194 Cardiovascular risk factor analysis for acute myocardial infarction patients in China.GAO Xiaojin（高曉津），et al.Dept Cardiol，Cardiovasc Instit &Fuwai Hosp，CAMS&PUMC，Beijing 100037.Chin Cir J 2015；30（3）：206-210.

Objective To describe the cardiovascular risk factor distribution for acute myocardial infarction（AMI）patients in China.Methods Based on the information of China acute myocardial infarction（CAMI）registry，we studied 17773 consecutive AMI patients from 107 hospitals among 31 provinces，cities and autonomous districts nationwide from 2013-01-01 to 2014-03-31.The patients included STEMI and non-STEMI，they were admitted within 7 days of onset and the cardiovascular risk factors were collected by questionnaire.The repairable risk factors were defined as smoking，over weight/obese，hypertension，dyslipidemia，diabetes，unhealthy living style as lack of excise and taking greasy food；un-repairable risk factor was defined as the family history of premature CAD.Results There were 15998/17773（90%）AMI patients with entire information enrolled for analysis，of whom 71.1%with STEMI and 74.0%with non-STEMI at the mean age of（67.4±14.4）years and mean BMI of（24.6±12.2）kg/m2.The first 3 repairable risk factors were smoking（54.4%），weight/obese（53.9%）and hypertension（51.2%），followedbydiabetes （19.5%）and dyslipidemia（7.7%）.There were 26.6% AMI patients with≥3 repairable risk factors，8.7% without repairable risk factor；3.6%with the family history of premature CAD.There were 76.2%of patients taking more greasy food，79.6%lack of excise.Compared with male patients，female were with elder age （67.4±14.4）years vs（59.8±14.8）years，more hypertension（61.8%vs 47.5%）and more diabetes （25.5%vs 17.4%）；while male patients were more with smoking history（69.2%vs 21.1%）and dyslipidemia（8.1%vs 6.7%），all P＜0.05.There were 4458/15998（27.9%）patients≤55 years of age，compared with those＞55 years，they were more with male gender（88.9%vs 68.2%），higher BMI（25.2±8.4）kg/m2vs（24.4±13.3）kg/m2，more dyslipidemia （10.0%vs 6.8），more smokers（70.1%vs 48.3%），taking more greasy food（83.4%vs 73.4%），and more family history of premature CAD（6.6%vs 2.4）；while the patients＞55 years were more with hypertension （55.3%vs 40.7%）and diabetes（21.1%vs 15.2%），all P＜0.05.Conclusion There are more than 1/4 AMI patients having≥3 repairable risk factors，more than half AMI patients having smoking history，over weight/obese and more than 80%of patients taking more greasy food and lack of exercises.

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2015195 The diagnostic value of HDL associated serum amyloid A to apolipoprotein A-I ratio in patients with coronary artery disease.ZHAO Hui（趙慧），et al.Key Lab，Clin Cardiovasc Drug Trial，Health Ministry，Cardiovasc Instit&Fuwai Hosp，CAMS&PUMC，Beijing 100037.Chin Cir J 2015；30（3）：211-215.

Objective To investigate the diagnostic value of high-density lipoprotein（HDL）associated serum amyloid A（SAA）to apolipoprotein A-I（apoA-I）ratio（SAA/ apoA-I）in patients with coronary artery disease（CAD）. Methods A total of 152 patients who received coronary angiography in our hospital were studied.According to the degree of coronary stenosis，the patients were divided into 2 groups.CAD group，n=77 and Control group，n=75.HDL was isolated by density gradient ultracentrifugation and the levels of SAA and apoA-I both in HDL and plasma were examined by ELISA.Results Compared with Control group，CAD group had increased ratio of HDL-SAA/HDL-apoA-I，P＜0.001.Multivariate logistic regression analysis indicated that the ratio of HDLSAA/HDL-apoA-I was independently related to the risk of CAD（OR=9.521，95%CI 3.345-27.100，P＜0.001）.Receiver operating characteristic curve（ROC）analysis presented that the ratio of HDL-SAA/HDL-apoA-I had the medium value for CAD diagnosis（AUC= 0.712，95%CI 0.632-0.793，P＜0.001），the best cut-off value was at 3.27.The plasma ratio of SAA/ apoA-I was positively related to the ratio of HDL-SAA/ HDL-apoA-I（r=0.857，P＜0.001），the ratio of SAA/ apoA-I had the similar value for CAD diagnosis（AUC= 0.676，95%CI 0.591-0.761，P＜0.001），the best cut-off value was at 8.3.Conclusion The ratio of SAA/ apoA-I in HDL is positively related to the risk of CAD，which might become a potential diagnostic marker in patients with CAD.

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2015196 Clinical value of three-dimensional speckle-tracking echocardiography for evaluating left ventricular diastolic function in patients with coronary artery disease.MA Hong（馬紅），et al.Dept Echocardiograph，Cardiovasc Instit&Fuwai Hosp，CAMS& PUMC，Beijing 100037.Chin Cir J 2015；30（3）：225-229.

Objective To investigate the clinical value of threedimensionalspeckle-trackingechocardiography（3DSTE）for evaluating left ventricular diastolic function in patients with coronary artery disease（CAD）.Methods A total of 68 CAD patients were prospectively recruited. According to left ventricular end-diastolic pressure（LVEDP），the patients were divided into 2 groups：Normal diastolic function group，the patients with LVEDP≤15 mmHg，n=31 and Diastolic dysfunction group，the patients with LVEDP＞15 mmHg，n=37.The global longitudinal strain（GLS），global circumferential strain （GCS），global area strain（GAS）and global radial strain（GRS）were analyzed with a commercial software （4D Auto LVQ）by the apical four chamber full-volume image.Results Compared with normal diastolic function group，the patients in diastolic dysfunction group showed obviously decreased GLS，GCS，GAS and GRS，P＜0.001.Pearson analysis presented that the above indexes were moderately related to LVEDP as for GLS（r= 0.585，P＜0.001），for GCS（r=0.589，P＜0.001），for GAS（r=0.674，P＜0.001）and for GRS（r= -0.643，P＜0.001）.The receiver operating characteristic（ROC）analysis showed that the sensitivity and specificity for diagnosing left ventricular diastolic dysfunction were at 68%and 68%when GLS=-15.5%，were at 76%and 81%when GCS=-17.5%，were at 84% and 68%when GAS=-29%respectively.Conclusion 3D-STE may predict LVEDP and it may be used as an alternative index of echocardiography in diagnosing left ventricular dysfunction in CAD patients with normal LVEF.

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2015197 Relationship between platelet/lymphocyte ratio and the severity of coronary lesion with short term prognosis in patients of ST-segment elevation myocardial infarction.XU Rui（徐銳），et al.Dept Cardiol，1st Affil Hosp，Xinjiang Med Univ，Urumqi 830054.Chin Cir J 2015；30（3）：230-234.

Objective To assess the relationship between platelet/lymphocyte Ratio（PLR）and the severity of coronary lesion with the short term outcome in patients of ST-Segment elevation myocardial infarction（STEMI）.Methods A total of 649 STEMI patients who received PCI in our hospital from 2008，January to 2013，December were recruited.According to SYNTAX score， the patients weredivided into 2 groups：Severe coronary lesion group，the patients with SYNTAX score＞22，n=231 and Moderate coronary lesion group，the patients with SYNTAX score≤22，n=418.Based on tierce of PLR，the patients were further divided into 3 groups：High PLR group，the patients with PLR≥207，n=216，Medium PLR group，the patients with 207＞PLR＞94，n=215 and Low PLR group，the patients with PLR≤94，n=218.The relationship between PLR and SYNTAX score，the relationship between 30 days all cause death and PLR were analyzed.Results The PLR in the severe coronary lesion group was higher than the moderate coronary lesion group，P＜0.001；SYNTAX score was positively related to PLR （r=0.34，P＜0.001）；PLR value was the independent risk factor for severe coronary lesion（OR=1.338%，95%CI 1.028-2.026，P＜0.001）.Multivariate Cox regression analysis showed that PLR was the independent predictor for 30 days all cause mortality in STEMI patients（HR=1.245，95%CI 1.153-1.825，P＜0.001）；Kaplan-Meier survival curve presented that with the elevation of PLR，the survival rate in STEMI patients decreased accordingly，P=0.019.Conclusion PLR is related to the severity of coronary lesion and it has certain predictive value for short term prognosis in STEMI patients.

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2015198 Quantitative evaluation of left ventricular remodeling using18F-FDG photon emission tomography imaging in patients with old myocardial infarction.WEI Hongxing（魏紅星），et al.Dept Nucl Med，Cardiovas Instit&Fuwai Hosp，CAMS&PUMC，Beijing 100037.Chin Cir J 2015；30（3）：235-239.

Objective To quantitatively and non-invasively evaluate both global and local left ventricular remodeling （LVRM）in patients with old myocardial infarction by18F-FDG photon emission tomography（PET）imaging with self developed soft ware.Methods A total of 33 patients received99Tcm-MIBI SPECT and gated18F-FDG PET/CT imaging and MRI within 2 weeks in our hospital were retrospectively studied.There were 21 patients with LV aneurysm and 12 with old myocardial infarction.A new developed software based on Matrix laboratory language was used to quantitatively evaluate the degree of global LVRM by spherical index（SI），and an index was firstly used for quantitatively evaluate the degree of local LVRM including the divergent pattern index（DPI）on the horizontal long-axis（HLA）and horizontal diameter ratio（HDR）on the short axis.MRI measured left ventricular end-diastolic volume（LVEDV）and LVESV was defined as“golden standard”for evaluating the degree of global RM.The degree of“divergent pattern”was visually analyzed by 2 experienced experts with a 4 points scoring system（1-4 score）based on the long horizontal axis and the long vertical axis of PET imaging.The relationshipsbetweenSIandMRImeasuredLVEDV，LVESV and LVEF were analyzed；meanwhile，the relationships between the experts visual scoring and DPI，HLA and HDR were studied.Results For global RM study，SI was positively related to LVEDV and LVESV （r=0.598，P＜0.01 and r=0.615，P=0.01），negatively related to LVEF（r=-0.587，P＜0.01）；for local RM study，the experts visual scoring was positively related to DPI of anterior-HLA（r=0.763，P＜0.01），middle-HLA（r=0.709，P＜0.01）and HDR on short axis（r=0.722，P＜0.01）.Conclusion Self developed new index of SI，DPI and HDR for PET myocardial metabolic imaging could evaluate both global and local degrees of LVRM in patients with old myocardial infarction.

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2015199 Relationship between plasma levels of high-sensitivity C-reactive protein and big endothelin-1 in patients with lone atrial fibrillation.ZHENG Lihui（鄭黎暉），et al.Arrhythmia Center，Cardiovasc Instit&Fuwai Hosp，CAMS&PUMC，Beijing 100037. Chin Cir J 2015；30（3）：240-243.

Objective To explore the relationship between different levels of plasma high-sensitivity C-reactive protein （hs-CRP）and big endothelin-1（big ET-1）in patients with different type of pure atrial fibrillation（AF）.Methods A total of 128 lone AF patients with NYHAⅠ to NYHAⅡand LVEF≥50%were divided into 2 groups：Paroxysmal AF group，n=83 and Persistent AF group，n=45.There was a control group，containing 82 patients of paroxysmal supra ventricular tachycardia with the matched age and gender.Plasma levels of hs-CRP，big ET-1 were examined and compared among different groups.Results①Compared with the control group，plasma levels of hs-CRP and big ET-1 were higher in both the paroxysmal and the persistent AF groups，P＜0.05.②Compared with the paroxysmal AF group，the patients in the persistent AF group showed a higher level of hs-CRP，P＜0.05，while the level of big ET-1 was similar between the 2 AF groups，P＞0.05.③In the paroxysmal AF group，plasma level of hs-CRP was positively related to ET-1（r=0.563，P＜0.05），and in the persistent AF group，hs-CRP was weakly related to ET-1 （r＜0.1）.Conclusion The pure AF patients have elevated plasma levels of hs-CRP and big ET-1，such elevation is more obvious in persistent AF patients；plasma level of hs-CRP is positively related to big ET-1 in paroxysmal lone AF patients.

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2015200 Upstream therapeutic strategies of valsartan and fluvastatin in treating patients with hypertension combining atrial fibrillation.Qi Wenwei（戚文威），et al.Dept Cardiol，2nd Hosp，Tianjin Med Univ，Tianjin 300211.Chin Cir J 2015；30（3）：251-255.

Objective To investigate weather valsartan and/or fluvastatin may reduce the recurrence rate of non-permanent atrial fibrillation（AF）in patients with hypertension，and to prolong the prognosis time from non-permanent AF to permanent AF.Methods Our research was named as VF-HF-AF study，a multicenter，randomized，open-label，four-arm parallel group study with comparative evaluation of valsartan and fluvastatin as upstream treatment in patients with hypertension combining nonpermanent AF.The primary endpoints were the prognosis rate from paroxysmal AF to persistent AF，and to study the prognosis rate from non-permanent AF to permanent AF during the observation period.The secondary endpoints include：myocardial infarction（MI），heart failure （NYHA Ⅲ orⅣ），cardiac shock，severe bleeding which needed admission，malignant ventricular arrhythmia，revascularization therapy（CABG/PCI），radiofrequency catheter ablation of AF，stroke，cardiac death，all causing mortality and AF recurrence.A total of 1879 patients would be investigated from 15 medical centers nationwide to obtain the relevant information.Results This is the first clinical trial for evaluating the impact of valsartan and/or fluvastatin in treating the patients with hypertension combining non-permanent AF in China，it will provide the upstream therapeutic experience for clinical practice.Conclusion This is the first clinical trial for evaluating the impact of valsartan and/or flurastatin in treating the patients with hypertension combining nonpermanent AF in China，which will provide the upstream therapeutic experience for clinical practice.

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