2023年 · 第03卷第02期

Objective: Arterial stiffness is an important predictor of cardiovascular disease. Microbial diversity in the gut has been shown to be associated inversely with arterial stiffness in Caucasian populations. However, due to the different profiles of the gut microbiota among ethnicities, the relationship between gut-microbiota dysbiosis and the progression of arterial stiffness merits further investigation. This study aimed to investigate the association between the composition and functional capacity of the gut microbiota and the progression of arterial stiffness. Methods: "Shotgun" metagenomics sequencing were undertaken in 96 individuals from a hypertension-associated gut-microbiota study in the Kailuan cohort, who measured brachial-ankle pulse wave velocity (baPWV) and provided fecal samples between September 2014 and February 2015 at Kailuan General Hospital and 11 affiliated hospitals. The different composition and functional capacity of the gut microbiota were compared between individuals without arterial stiffness (normal arterial stiffness group, baPWV <1,400 cm/s, n = 27) and participants with arterial stiffness (increased arterial stiffness group, baPWV ≥1,400 cm/s, n = 69) at baseline. These participants were followed up prospectively for a mean duration of 2.6 years, and 50 underwent a repeat baPWV measurement. Associations between the gut microbiota and severity and progression of arterial stiffness were assessed using MaAsLin2 software after adjustment for age, sex, and mean arterial blood pressure and correction for multiple testing. Gene "catalogs" were aligned to the Kyoto Encyclopedia of Genes and Genomes (KEGG) database to obtain information for potential functional capacities of the gut microbiota. Results: In this study, 14 genera and 50 species of bacteria were identified to be abundant in participants with normal arterial stiffness compared with those with increased arterial stiffness. Of 14 genera, the prevalence of beneficial bacteria of the genera Leadbetterella and Cytophaga was correlated inversely with baPWV (P < 0.05). Analyses of functional capacity revealed gut-microbial dysfunctions in the synthetic processes of "threonine dehydratase" "hypothetical protein" "mannosyl transferase" and "type-IV secretion-system proteins" in individuals suffering from arterial stiffness. During follow-up, bacteria of the proinflammatory genera Escherichia, Shigella, and Ruegeria were enriched in individuals with increased baPWV. Functional analyses showed that 26 KEGG orthologs of gut microbes were associated with an increase in baPWV and involved in "carbohydrate metabolism" "amino acid metabolism" and "protein families related to genetic information processing." Conclusions: The composition and functional capacity of the microbial community in the gut of people suffering from arterial stiffness differed from those in individuals not suffering from arterial stiffness. Our data provide a new direction for the causality of the host-gut microbiota in arterial stiffness.

Objective: The size and morphology of the right ventricular outflow tract (RVOT) in patients suffering from long-term pulmonary regurgitation (PR) after native RVOT (NRVOT) reconstruction are important factors affecting the feasibility, safety, and effectiveness of transcatheter pulmonary valve replacement. The purpose of this study was to evaluate the feasibility, safety, and effectiveness of a transthoracic Salus valve (Balance Medical Technology Co., Ltd, Beijing, China) in patients with moderate-to-severe PR after NRVOT reconstruction. Methods: Patients with moderate-to-severe PR after NRVOT reconstruction were selected between June 2021 and November 2021 at Beijing Anzhen Hospital. Demographic data as well as preoperative, intraoperative, and follow-up data were reviewed. Results: Ten patients with moderate-to-severe PR after NRVOT reconstruction underwent physical examination, transthoracic echocardiography, and cardiovascular magnetic resonance imaging. Seven patients were selected for transthoracic Salus valve replacement. Six patients underwent implantation of the Salus valve successfully. One valve migrated and was embolized during recovery of the delivery device; the Salus valve was surgically explanted and sutured to the inner wall of the main pulmonary artery. At a mean follow-up of (5.5 ± 1.1) months, dysfunction or migration of the Salus valve embolism was not observed. Conclusions: This early feasibility study demonstrates the feasibility, safety, and effectiveness of transthoracic implantation of a Salus valve in patients with moderate-to-severe PR after NRVOT reconstruction. The short-term effectiveness is clear, medium and long-term effectiveness requires longer follow-up.

Objective: Computed tomography pulmonary angiography (CTPA) parameters are valuable for predicting pulmonary hypertension (PH) in patients with pulmonary embolism (PE). However, few studies have used the coronary sinus ostium area (CSOA), derived from CTPA, to detect PH. This study aimed to compare the prognostic values of the CSOA, coronary sinus ostium diameter (CSOD), and right ventricular (RV)/left ventricular (LV) ratio for PH. Methods: This study retrospectively analyzed 78 patients (mean age, (51.94 ± 12.33) years; 53.8% male) with acute PE confirmed by CTPA at the Sixth and Eighth Medical Centers of the People’s Liberation Army General Hospital between June 2018 and June 2020. Patients were categorized into 2 groups using a pulmonary artery systolic pressure (PASP) cut-off of 30 mmHg. CTPA parameters were compared between these groups. Results: Patients with PASP >30 mmHg (n = 22) had a larger CSOA, CSOD, RV diameter, RV/LV ratio, and inferior vena cava diameter compared with patients with PASP ≤30 mmHg (n = 56). The CSOA had an area under the receiver-operating characteristic curve (AUC, 0.84; 95% confidence interval (CI), 0.74-0.94; P < 0.001) similar to that of the RV/LV ratio (AUC, 0.85; 95%CI, 0.73-0.99; P < 0.001), while that of the CSOD was smaller (AUC, 0.66; 95%CI, 0.51-0.81; P < 0.05). Conclusion: Both CSOA and CSOD demonstrated a good ability to predict PH, while CSOA better predicted PASP >30 mmHg.

Objective: Pulmonary arterial hypertension (PAH) is a cardiovascular disease caused by primary proliferative lesions in pulmonary arterioles. Competing endogenous RNAs (ceRNAs) have been reported to act as sponges for microRNAs (miRNAs). To date, however, the mechanisms underlying ceRNA involvement in PAH have not been investigated. This study aimed to construct a PAH-related ceRNA network to further explore the mechanisms of PAH. Methods: A probe reannotation was conducted to identify the long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) involved in PAH. Based on the reannotation results, the "limma" package was used to identify the differentially expressed genes (DEGs) and lncRNAs. The miRcode database was used to predict the lncRNA-miRNA interactions. Then, the mRNAs targeted by the miRNAs were predicted by using TargetScan, miRTarBase, and miRDB. Based on the above interactions, a ceRNA network was constructed, which was mapped and visualized with Cytoscape 3.6.1 software. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using the database. To predict possible drugs or molecules that may mitigate PAH, C-Map analysis was applied to find relevant molecular compounds that can reverse the expression of DEGs in cell lines. Results: The ceRNA network consisted of 174 nodes and 304 links, which included 10 lncRNAs, 23 miRNAs, and 53 mRNAs. The hub genes of the ceRNA network for PAH included hsa-miR-17-5p, hsa-miR-20b-5p, MEG3, HCP5, hsa-miR-27a-3p, hsa-miR-107, hsa-miR-142-3p, hsa-miR-363-3p, hsa-miR-301b-3p, and hsa-miR-23b-3p. Calprotectin, irinotecan, and medrysone were found to be the 3 significant compounds. Conclusion: This study found that hsa-miR-17-5p, hsa-miR-20b-5p, MEG3, HCP5, hsa-miR-27a-3p, hsa-miR-107, hsa-miR-142-3p, hsa-miR-363-3p, hsa-miR-301b-3p, and hsa-miR-23b-3p maybe the underlying biomarkers and targets for diagnosis and treatment of PAH.

Objective: This study aimed to evaluate the major adverse cardiovascular and cerebrovascular events (MACCEs) and overall safety profile associated with iodixanol in Chinese patients undergoing percutaneous coronary intervention (PCI). Methods: Patients at 30 centers in China registered in the OpenClinic v3.6 database from October 30, 2013, to October 7, 2015, were included in the study. The primary endpoint was in-hospital MACCEs including target lesion revascularization (TLR), stroke, stent thrombosis, cardiac death, and PCI-related myocardial infarction (MI) within 72 h post-PCI. Secondary endpoints were MACCEs from 72 h to 30 d post-PCI and other safety events within 30 d post-PCI. Results: A total of 3,042 patients were enrolled. The incidence of MACCEs within 72 h post-PCI was 2.33% (n = 71), including cardiac death (0.03%, n = 1) and PCI-related MI (2.30%, n = 70). The incidence of MACCEs from 72 h to 30 d post-PCI was 0.16% (n = 5), including cardiac death (0.10%, n = 3), PCI-related MI (0.03%, n = 1), and TLR for stent thrombosis (0.03%, n = 1). The incidence of composite angiographic or procedural complications was 2.86% (n = 87); 233 (7.86%) patients had results suggesting contrast-induced acute kidney injury. Conclusions: These findings indicate that the use of iodixanol in Chinese patients undergoing PCI is associated with a low incidence of MACCEs, confirming its safety in this population.

Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of berberine treatment in improving blood glucose, blood lipids, and blood pressure as well as the associated safety profile. Methods: PubMed, Embase, Cochrane Library, WanFang Data, and the China National Knowledge Infrastructure database were searched from the establishment of the database to December 31, 2021, to identify randomized, double-blind trials that examined the effect of berberine alone or as add-on treatment on blood glucose, blood lipids, and blood pressure with an intervention period of at least 3 months. Two researchers independently screened articles, extracted data, and assessed the quality of each study according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The efficacy outcomes included fasting blood glucose (FPG), 2-hour post-prandial glucose (2hPG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The safety outcome was the incidence of the total number of adverse events. Results: A total of 17 articles enrolling 1,485 participants were included in the meta-analysis. The intervention duration ranged from 12 to 24 weeks. Sixteen trials reported results for blood glucose, 14 trials reported results for blood lipids, and 7 reported results for blood pressure. Compared with placebo or baseline treatment, berberine alone or as add-on therapy significantly reduced FPG (by 0.35 mmol/L; 95% confidence interval (CI): 0.13-0.58 mmol/L; P = 0.002; I2 = 89.0%, n = 16), 2hPG (by 1.50 mmol/L; 95% CI: 0.50-2.49 mmol/L, P = 0.003, I2 = 84.1%, n = 4), HbA1c (by 0.45%, 95% CI: 0.24%-0.65%, P < 0.001, I2 = 82.8%, n = 9), TC (by 0.48 mmol/L; 95% CI: 0.36-0.60 mmol/L, P < 0.001, I2 = 72.3%, n = 13), TG (by 0.22 mmol/L; 95% CI: 0.13-0.31 mmol/L, P < 0.001, I2 = 57.1%, n = 14), and LDL-C (by 0.41 mmol/L; 95% CI: 0.34-0.48 mmol/L, P < 0.001, I2 = 35.0%, n = 12). The effect on blood glucose and blood lipids remained consistent when confined to high-quality trials. There is no significant effect of berberine treatment on HDL-C, SBP, and DBP. The incidence of the total number of adverse events was similar between the berberine group and the control group (risk ratio (RR) = 1.00, 95% CI: 0.84-1.19, P = 0.961). Gastrointestinal disorder was the most common adverse event in the berberine group and most adverse events were alleviated or disappeared as the dose was decreased or the intervention time was prolonged. Conclusions: Short-term berberine treatment significantly improved blood glucose and blood lipid profiles without raising safety concerns. A rigorously designed randomized controlled trial could be considered to examine the feasibility of the long-term application of berberine treatment in the prevention of cardiovascular disease.

Improving exercise tolerance is indisputably beneficial for long-term survival in patients treated with percutaneous coronary intervention (PCI). Although previous studies suggested that Yangxinshi tablets effectively improve exercise tolerance in patients with coronary heart disease, the evidence is limited due to the lack of high-quality randomized trials. The Effects of Yangxinshi Tablets on Exercise Tolerance Compared with Trimetazidine in Patients after PCI (HEARTRIP) trial is a multicenter, double-blind, double-dummy, active drug-controlled, randomized trial designed to test if the effects of Yangxinshi tablets on exercise tolerance are non-inferior to those of trimetazidine in patients undergoing PCI. A total of 668 patients who have undergone PCI for the first time and completed a cardiopulmonary exercise test (CPET) will be enrolled and randomly assigned, in a 1:1 ratio, to receive Yangxinshi tablets (3 tablets, 3 times/d) plus trimetazidine-placebo or trimetazidine (20 mg, 3 times/d) plus Yangxinshi-placebo for 24 weeks. The primary endpoint is metabolic equivalent of tasks (METs) measured by CPET at 24 weeks after randomization. The secondary endpoints include comprehensive CPET indicators, incidence of major adverse cardiac and cerebrovascular events, and depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and quality of life (Seattle Angina Questionnaire) scores. This study will appraise current clinical evidence on the beneficial effect of Yangxinshi tablets on improving exercise tolerance after PCI and may substantiate their use as an effective pharmacological option for cardiac rehabilitation patients. The HEARTRIP study protocol received approval from the ethics committee of the General Hospital of Northern Theater Command (Shenyang, China). The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results will be published following the guidelines of the CONSORT statement in a peer-reviewed scientific journal (Trial registration number: NCT03809273).

Pulmonary vein stenosis (PVS) is an extremely rare and lethal disease caused by multiple etiologies. PVS has a bimodal distribution in the population, affecting children and adults. Congenital PVS is the usual PVS type in children, which sometimes develops after cardiothoracic surgery. Acquired PVS, in turn, is the most common PVS type in adults. A review of the relevant literature has shown that PVS after radiofrequency ablation of atrial fibrillation is the most common, as well as that caused by compression of proliferative fibrous tissues or tumor in the mediastinum (eg, PVS caused by fibrosing mediastinitis, lung tumors, metastases, etc). This article provides a comprehensive review of PVS in terms of embryology and anatomy, etiology and triggers, classification, clinical symptoms and signs, treatment, and prognosis, intending to promote the understanding and treatment of this disease.

Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of pulmonary tumors, lung lobectomy, and atrial fibrillation ablation. Although it is a potentially life-threatening condition, it is easily misdiagnosed because of non-specific symptoms and its characteristics on imaging modalities. Here, we report a case of thrombotic occlusion at the ostium of the left superior pulmonary vein resulting from pulmonary vein stenosis following radiofrequency ablation for atrial fibrillation. This report extends the available approach with anticoagulant therapy and interventional angioplasty to pulmonary vein thrombosis secondary to pulmonary vein stenosis.

Severe coronavirus 2019 (COVID-19) infection is associated with myocardial injury and arrhythmia. Bradycardia is a newly recognized consequence of COVID-19. Relative bradycardia and its effects in 4 critically ill patients with COVID-19 was described in this case series. The 4 cases showed the same clinical phenomenon: sinus bradycardia without a compensatory increase in heart rate in response to elevation of body temperature. Typically, heart rate decreases as body temperature rises. The 4 patients were all men with an average age of 67 years. Patient 1 was a 78-year-old man with no major medical history who died from COVID-19 pneumonia. The other 3 patients recovered.