Cardiology

Cholesterol-mediated regulation of angiogenesis: An emerging paradigm Lingping Zhu, Qilin Gu, Longhou Fang Cardiology Plus 2019 4(1):1-9 Angiogenesis, the fundamental process that generates new blood vessels from parental vessels, is essential for embryogenesis and pathogenesis. A variety of underlying molecular and cellular mechanisms control angiogenesis. In this review, we focus on a unique mechanism of action – cholesterol-regulated angiogenesis. We will discuss lipoproteins, including low-density lipoprotein and high-density lipoprotein, cholesterol-rich lipid rafts/caveolae, apoA-I-binding protein (AIBP, also known as NAXE)-regulated cholesterol efflux, the effect of the hydroxycholesterol-activated nuclear receptor liver X receptor α/β on the proangiogenic vascular endothelial growth factor receptor 2 and antiangiogenic Notch signaling, and cholesterol-modified sonic hedgehog signaling. These pathways can be exploited, either alone or in conjunction with the currently available regimen for angiogenesis treatment, to control neovascularization in dyslipidemia. A treatment protocol for angiogenesis that takes into consideration cholesterol management might constitute an important component in precision and personalized medicine.

High voltage J-waves as a predictor of death in acute ST-Segment elevated myocardial infarction in hospital Hongbing Li, Hao Li, Yan Song, Dongqi Wang, Juan Shu, Changcong Cui, Fangqi Han, Yue Wu, Gang Tian Cardiology Plus 2019 4(1):10-14 Aims: Stratification of the risk of malignant arrhythmias in patients with coronary artery disease remains a challenge. This study evaluated the potential of high voltage J-waves in patients with acute ST-segment elevated myocardial infarction (STEMI) to predict the risk of malignant arrhythmias during hospitalization. Methods: A total of 128 consecutive STEMI patients with J-waves were enrolled within 48 h after the onset of the STEMI in this prospective study. The mean age was 62.97 ± 12.1 years, and 108 patients were male. Both 12-lead electrocardiograms (ECGs) and right-sided chest lead ECGs were recorded simultaneously within 10 min of admission to the hospital. Continuous ECG monitoring was administered from admission until discharge. Clinical characteristics and ECG parameters were compared between patients who survived and those who died during hospitalization. Results: Malignant ventricular arrhythmias (MVAs) were seen with J-waves more frequently in STEMI patients who subsequently died (P < 0.05). J-wave voltage, QTDc, Tp-e, and the Tp-e/QT ratio increased significantly in patients who died (P < 0.05). Multivariate logistic regression analysis revealed that J-wave voltage (odds ratio [OR], 89.09; 95% confidence interval [CI], 2.606-3045.108; P < 0.05) and MVAs (OR, 4.296; 95% CI, 1.348–13.693; P < 0.05) were associated with the occurrence of sudden death in patients with STEMI during hospitalization. Conclusions: High voltage J-waves are a potential ECG parameter for predicting sudden death in patients with STEMI during hospitalization.

Right ventricular systolic function and cardiac resynchronization therapy Lu Tang, Nianwei Zhou, Xue Gong, Shengmei Qin, Zhaohua Yang, Zhenning Nie, Shimo Dai, Quan Li, Yangang Su, Cuizhen Pan, Xianhong Shu Cardiology Plus 2019 4(1):15-21 Objectives: The aim of this study was to investigate the influence of right ventricular (RV) dysfunction on the response to cardiac resynchronization therapy (CRT) and the impact of CRT on RV function in a beagle model of heart failure (HF). Methods: Twenty-one beagles were implanted with transvenous cardiac pacemakers and underwent rapid RV pacing for 2 weeks at 260 bpm to induce HF. Dogs were subsequently divided into three groups that were either treated with bi-ventricular pacing (CRT group) or untreated (control group and HF group). Echocardiographic images were acquired at baseline, before CRT, and 4 weeks after CRT. Results: Left ventricular systolic function and synchrony (left ventricular internal dimensions, left ventricular end systolic volume [LVESV], left ventricular ejection fraction [LVEF], septal-to-posterior wall motion delay [SPWMD], and aorta pre-ejection interval and the pulmonary artery pre-ejection interval [|APEI-PPEI|]) were significantly improved in the CRT group compared with the HF group. RV myocardial performance index (MPI) and pulmonary artery systolic pressure deteriorated with left ventricular dysfunction and improved after CRT. RV outflow ESV, standard deviation of time to minimum systolic volume (Tmsv), and Tmsv% decreased in the CRT group compared with the HF group. LVESV, LVEF, SPWMD, and |APEI-PPEI| were significantly different between responders and nonresponders, while there was no difference about RV functional parameters. Conclusions: RV function deteriorated with left ventricular dysfunction and improved after CRT. RV function did not significantly influence the response to CRT.

Correlation between plasma-soluble angiotensin-converting enzyme 2, anti- angiotensin-converting enzyme 2, and angiotensin-(1–7) in patients with chronic heart failure Yi Gu, Xiao-Hui Yang, Muhammad Nabeel Dookhun, Jian-Song Zhou, Si-Liang Xia, Hui Zhang, Xiao-Yi Qin, Yu-Qing Yang, Jia-Li Cao, Hua-Yi-Yang Zou, Xiao-Qian Xiao, Xin Zheng Lu Cardiology Plus 2019 4(1):22-28 Background: Angiotensin-converting enzyme 2 (ACE2) is an ACE homolog that converts angiotensin II into angiotensin-(1–7) (Ang-[1–7]). Tumor necrosis factor α (TNF-α), interleukin-1 β, and interleukin-6 are plasma inflammatory cytokines that play a role in the development of hypertension and chronic heart failure (CHF). However, the relationship between soluble ACE2 (sACE2), Anti-ACE2, Ang-(1–7), and the plasma inflammatory cytokines during the development of CHF remains unclear. Methods and Results: A total of 135 patients with CHF were enrolled in this study (63 males and 72 females), with left ventricular ejection fraction (LVEF) <50%. The height and body weight of each patient was measured to calculate the body mass index. The plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using immunofluorescence. The patients were divided into four groups according to the quartiles of NT-proBNP levels. The plasma concentrations of sACE2, anti-ACE2, Ang-(1–7), and TNF-α were measured by enzyme-linked immunosorbent assay. The plasma ACE2, anti-ACE2, Ang-(1–7), and TNF-α levels in CHF patients increased with increasing NT-proBNP levels (P < 0.01). The plasma sACE2, anti-ACE2, Ang-(1–7), and TNF-α levels were positively correlated with NT-proBNP levels (r = 0.587, r = 0.949, r = 0.614, and r = 0.711, respectively; P < 0.01). Multiple linear regression analysis showed that TNF-α, Ang-(1–7), and LVEF are independent predictors for NT-proBNP in patients with CHF. Conclusions: The plasma sACE2, anti-ACE2, Ang-(1–7), and TNF-α levels increased in CHF patients with increasing NT-proBNP levels. The simultaneous detection of these markers is significant for diagnosing patients with CHF.

Associations of extremely hot weather and cardiovascular disease mortality: Results from 2011 to 2017, Jinan City, China Ruoming Cao, Lin Zhou, Jiayu Xu, Liangliang Cui Cardiology Plus 2019 4(1):29-34 Objective: The main objective of this study is to investigate the acute effects of extremely high-temperature weather and heat waves on the risk of cardiovascular disease (CVD) resulting in the death in Jinan City, China. Methods: We collected the daily CVD death cases of permanent residents, daily weather data, and air pollution data (PM2.5, SO2, NO2, and O3) from Jinan, China, from 2011 to 2017 for May–September, when the temperatures are their highest. Three levels of extremely high-temperature weather were defined by the 90th percentile (29.5°C), the 95th percentile (30.6°C), or the 99th percentile (32.4°C) of daily mean temperature. They are represented by P90, P95, and P99, respectively. The definition of heat wave also included three levels, namely, Heat Wave I, Heat Wave II, and Heat Wave III for the P90, P95, and P99 of daily average temperatures that lasted for 3 days or longer. A time-stratified case-crossover study was used to assess the acute effects of extremely hot weather and heat waves on the risk of CVD death with a lag time of 6 days. Results: A total of 54,374 CVD deaths were detected during the study, with an average of 52 deaths/day. No Heat Wave III was present between 2011 and 2017. The maximum effect of P90, P95, and P99 on CVD death occurred in Lag 1 with odds ratio values of 1.21 (95% confidence interval [CI]: 1.16-1.66), 1.25 (95% CI: 1.18–1.32), and 1.28 (95% CI: 1.13-1.45). At Lag 1, Heat Wave I increased the risk of CVD death by 1.30 (95% CI: 1.23–1.37); at Lag 2, Heat Wave II increased the risk of CVD death by 1.47 (95% CI: 1.36–1.59). Conclusions: A 7-year analysis of Jinan City, China, found that extremely high-temperature weather and heat waves can lead to a significant increase in the risk of death from CVD, suggesting that a health-risk management and response mechanism should be established that include both extreme high temperatures (day effect) and heat waves (sustained effect).

Intermittent high-spiking fever, muscle and joint pain with sudden chest pain: Adult-onset still's disease? Wei Li, Peng Dong, Fang Liu, Yang Jiang, Yuanzheng Li, Banghe Li Cardiology Plus 2019 4(1):35-38 Adult-onset Still's disease (AOSD) is a clinical syndrome characterized by long-term intermittent fever, transient polymorphic rash, arthritis or arthralgia, pharyngalgia, and accompanied by systemic involvements. The pathophysiology of AOSD has recently been classified as a complex autoinflammatory disease. Sometimes it is necessary to differentiate from coronary heart disease. In recent years, anakinra has been used to treat AOSD with promising results.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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alsfakia@gmail.com