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Association between non-alcoholic fatty liver disease and coronary artery disease severity

Chinese Medical Journal 2011年第6期124卷 867-872页

作者： SUN Ling lu shu-zheng Department of Cardiology Fushun Central Hospital FushunLiaoning 113006 China Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Background Both non-alcoholic fatty liver disease （NAFLD） and coronary artery disease （CAD） are closely associated with many metabolic disorders. Invasive coronary angiography （CAG） is a common approach as an intervention for CAD.However, the association between angiographic severity of coronary artery and NAFLD remains controversial. This study aimed to evaluate the relationship between NAFLD and CAD.Methods Totally 542 consecutive patients who planned to undergo CAG due to a suspected CAD were enrolled.Abdominal computed tomography （CT） was performed before angiography to detect NAFLD. CAD was defined as stenosis of at least 50% in at least one major coronary artery. The severity of CAD was assessed by the number of vessels affected and the vessel score multiplied by the severity score （Gensini score）. Significant stenosis was defined as 70% or greater reduction in lumen diameter. A probability value of P 〈0.05 was considered statistically significant.Results Of 542 patients studied, 248 （45.8%） were found to have NAFLD by abdominal CT, and 382 patients （88%）were found to have significant CAD by CAG. Age, diabetes mellitus, waist circumference, body mass index, and obesity were associated with NAFLD. According to the results of Logistic regression analysis, the presence of NAFLD independently increased the risk for CAD, as seen in CAG （odds ratio （OR）, 95% confidence interval （CI）： 7.585（4.617-12.461）; P 〈0.001）. NAFLD was significantly more common in patients as CAD severity increased （P〈0.001）.Conclusions The presence of NAFLD is associated with high severity of CAD, requiring that patients with abdominal obesity be also investigated for NAFLD. Patients with NAFLD should be closely followed up for the presence and severity of CAD.

关键词： non-alcoholic fatty liver disease coronary artery disease computed tomography

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Proliferation, migration and apoptosis activities of endothelial progenitor cells in acute coronary syndrome

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Chinese Medical Journal 2010年第19期123卷 2655-2661页

作者： ZHANG Li-jie LIU Wen-xian CHEN Yun-dai SONG Xian-tao JIN Ze-ning lu shu-zheng Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiology Chinese People's Liberation Army General Hospital Beijing .100853 China

Background There are numerous articles on the endothelial progenitor cells （EPCs） in different disease conditions. However, the functional properties of EPCs in acute coronary syndrome （ACS） are still uncertain. Here we aimed to study the number and functions of EPCs in ACS patients. Methods Patients were enrolled with admitted ACS （n=25） and another 25 gender-, age-, atherosclerotic risk factors-matched stable coronary artery disease （CAD） controls. EPCs were defined as CD34＋/CD133＋/VEGFR-2＋ and quantified by flow cytometry. Moreover, functional properties of EPCs including colony-forming unit （CFU）, proliferation, migration as well as apoptosis were evaluated and compared between the two groups. Plasma matrix metalloproteinase-9 （MMP-9） was detected in all patients as well. Results The two groups had similar medication and clinical characteristics on admission. The EPCs in ACS patients were more than 2.6 times that in stable CAD subjects （15.6±2.7 vs. 6.0±0.8 /100 000 events, P 〈0.01）. CFU was not statistically different between the two groups （10.8±2.9 vs. 8.2±1.8, number/well, P 〉0.05）. Furthermore, EPCs isolated from ACS patients were significantly impaired in their proliferation （0.498±0.035 vs. 0.895±0.067, OD value, P〈0.01） and migration capacity （20.5±3.4 vs. 30.7±4.3, number/well, P 〈0.01） compared with controls. Moreover, the apoptosis cell in cultured EPCs was drastically increased in ACS group （（18.3±2.. 1 ）% vs. （7.8±0.4）%, P 〈0.01）. Conclusions Patients with ACS exhibited apparently increased circulating EPCs as well as cultured apoptosis percentage together with a remarkable impairment of proliferation and migration activities compared with stable CAD subjects.

关键词： endothelial progenitor cells acute coronary syndromes number function

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Comparision of high sensitivity C-reactive protein and matrix metalloproteinase 9 in patients with unstable angina between with and without significant coronary artery plaques

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Chinese Medical Journal 2011年第11期124卷 1657-1661页

作者： WANG Li-xin lu shu-zheng ZHANG Wei-jun SONG Xian-tao CHEN Hui ZHANG Li-jie Department of Cardiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China Institute of Biomedical Engineering Capital Medical UniversityBeijing 100069 China

Background Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein （CRP） is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 （MMP-9） is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.

关键词： unstable angina high sensitivity C-reactive protein matrix metalloproteinase 9 coronary artery stenosis angiography

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Evaluation of neointimal coverage of overlapping sirolimus- eluting stents by optical coherence tomography

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Chinese Medical Journal 2009年第6期122卷 670-674页

作者： TIAN Feng CHEN Yun-dai SUN Zhi-jun CHEN Lian YUAN Fei SONG Xian-tao lu shu-zheng Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiology Chinese General Hospital of PLA Beijing 100853 China

Background Although overlapping sirolimus-eluting stents are often used in long lesions during percutaneous coronary intervention, it was not clear how intimal hyperplasia at the overlapping segments compares with that of single-layer sirolimus-eluting stents.Methods Optical coherence tomography （OCT） examinations were performed on 22 patients in whom overlapping sirolimus-eluting stents （SESs） were implanted. OCT images were analyzed off-line after the procedure. Still frames were selected and classified, and the length of overlap, lumen loss, and average neointimal thickness on the strut were measured. The stent strut was classified into well-apposed to vessel wall with apparent neointimat coverage （type A）, well-apposed to vessel wall without neointimal coverage （type B）, malapposed to the vessel wall without neointimal coveraae （tvDe C）, and strut located at a major side branch （type D）.Results Tlqere was no statistically significant difference between strut coverage types within overlapping and non-overlapping segments, but a greater percentage of type C struts were observed within the overlapping segments （5.2% vs 1.4%, P 〉0.05）. Neither neointimal thickness （（175.0±59.9） μm vs （168.3±90.2）μm, P=0.715） nor lumen loss （（1.61±0.55） mm^2 vs （1.48±0.37） mm^2, P=0.397） was statistically different between the two segments. One patient was diagnosed with suspected in-stent thrombosis at 6 months. Although no specific characteristics of thrombosis were seen on the OCT images, a greater number of malapposed struts without neointima coverage were observed.Conclusions About 90% struts were completely covered by neointimal proliferation at 12 months follow-up, and the thicknesses of neointima on overlapping and non-overlapping segments were similar. Most of type C struts at the overlapping segments were found on the inside layer stents. Delayed antiplatelet therapy was beneficial for the patients with incompletely covered struts.

关键词： sirolimus-eluting stent coronary artery disease overlapping optical coherence tomography

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Combined effect of atorvastatin and probucol on plasma cystatin C levels and severity of coronary lesion in patients with borderline coronary lesion

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Chinese Medical Journal 2012年第14期125卷 2472-2476页

作者： GE Chang-jiang lu shu-zheng FENG Li-xia HUO Yong SONG Xian-tao CHEN Xin MENG Kang YUAN Fei Department of Cardiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China Department of Cardiology. Peking University First Hospital Beijing 100034 China

Background The plasma cystatin C concentration （PcyC） has been demonstrated to have prognostic value in acute coronary syndrome, but the study of PcyC in patients with borderline coronary lesions is limited. Moreover, the effects of atorvastatin and probucol on PcyC and the severity of coronary lesions are unknown. This study was to evaluate the effects of the combination of atorvastatin and probucol on PcyC and severity of coronary lesion in patients with borderline coronary lesions. Methods One hundred and thirty consecutive patients with borderline coronary lesions （40% to 60% isolated single stenosis assessed by quantitative coronary angiography） were enrolled into the borderline coronary lesion （BCL） group, and one hundred and thirty-six subjects without coronary lesions comprised the controls （CTR）. The subjects in the BCL group were randomized into routine treatment （RTT, n=60）, and combined treatment with atorvastatin 20 mg plus probucol 1.0 g daily added to routine medication （CBT, n=70）, both groups were treated for 6 months continuously. The levels of PcyC, high-sensitive C-reactive protein （hs-CRP）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C）, and triglycerides （TG） were determined. One hundred and four subjects in the BCL group were rechecked by coronary angiography. Results PcyC levels were significantly higher in the BCL group than in the CTR group; （2003.26＋825.73） ng/ml vs. （1897.83＋664.46） ng/ml （P 〈0.01）. Compared with patients in the RTT group, the levels of PcyC, TC, LDL-C, TG and hs-CRP were significantly lower in the CBT group （P 〈0.05）. Moreover, there was a trend towards a slight decrease in the RTT patients, （54.38＋10.67）% vs. （50.29＋9.89）% （P 〉0.05）, and a significant decrease in the CBT patients, （53.65＋9.48%） vs. （40.38＋12.93）% （P 〈0.05）, in the mean percent stenosis of borderline coronary lesions before and after six months of treatment. Conclusions Cystatin C played an important role in with the severity of corona

关键词： cystatin C coronary artery disease,＂ borderline coronary lesion

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Effectiveness of Integrative Medicine Therapy on Coronary Artery Disease Prognosis: A Real-World Study

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Chinese Journal of Integrative Medicine 2019年第1期25卷 9-15页

作者： ZHAO Kang TIAN Jin-fan ZHAO Cong YUAN Fei GAO Zhu-ye LI Li-zhi LIU Hong-xu WANG Xian GE Chang-jiang lu shu-zheng Department of Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases Center for Cardiovascular Diseases Xiyuan Hospital China Academy of Chinese Medical Sciences Department of Cardiology Beijing Chinese Medicine Hospital Affiliated to Capital Medical University Department of Cardiology Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine

Objective: To evaluate the effectiveness of integrative medicine(IM) on patients with coronary artery disease(CAD) and investigate the prognostic factors of CAD in a real-world setting. Methods: A total of 1,087 hospitalized patients with CAD from four hospitals in Beijing, China were consecutively selected between August 2011 and February 2012. The patients were assigned to two groups based on the treatment: Chinese medicine(CM) plus conventional treatment, i.e., IM therapy(IM group); or conventional treatment alone(CT group). The endpoint was major adverse cardiac events [MACE; including cardiac death, myocardial infarction(MI), and revascularization]. Results: A total of 1,040 patients finished the 2-year follow-up. Of them, 49.4%(514/1,040) received IM therapy. During the 2-year follow-up, the total incidence of MACE was 11.3%. Most of the events involved revascularization(9.3%). Cardiac death/MI occurred in 3.0% of cases. For revascularization, logistic stepwise regression analysis revealed that age 65 years [odds ratio(OR), 2.224], MI(OR, 2.561), diabetes mellitus(OR, 1.650), multi-vessel lesions(OR, 2.554), baseline high sensitivity C-reactive protein level 3 mg/L(OR, 1.678), and moderate or severe anxiety/depression(OR, 1.849) were negative predictors(Plure(OR, 7.969) were negative predictors(Plusion: In a real-world setting, for patients with CAD, IM therapy was associated with a decreased incidence of revascularization and showed a potential benefit in reducing the incidence of cardiac death or MI.

关键词： coronary artery disease Chinese medicine integrative medicine effectiveness real-world study

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Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

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Chinese Medical Journal 2011年第8期124卷 1169-1174页

作者： LIU Wei MA Chang-sheng KANG Jun-ping DU Xin CHEN Fang ZHOU Yu-jie lu shu-zheng HUANG Fang-jiong GU Cheng-xiong ZHU Xiao-Ling Department of Carcliology Beiiing Anzllen Hospital Capital Medical University Beijing 100029 China Department of Cardiac Surgery Beijing Anzllen Hospital Capital MedicalUniversity Beijing 100029 China

Background In patients with chronic total occlusion （CTO） and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent （DES） implantation with coronary artery bypass surgery （CABG）in the patients with CTO and multivessel disease.Methods From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG （n=679） or DES （n=267） treatment. Their propensity risk score was used for adjusting baseline differences.Results At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events （MACCE） was lower in CABG group （12.7% vs. 24.3%, hazard ratio （HR） 1.969, 95% Cl 1.219-3.179, P=0.006） mainly due to lower rate of target vessel revascularization in CABG group than in DES group （3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P ＜0.001）. The incidence of cardiac death or myocardial infarction （composite end point） was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction （LVEF）, and complete revascularization were identified as significant predictors of composite end points.Conclusions Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

关键词： chronic total occlusion drug eluting stent cardiopulmonary bypass complete revascularization

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~rognostic value of baseline C-reactive protein levels in patients mdergoing coronary revascularization

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Chinese Medical Journal 2010年第13期123卷 1628-1632页

作者： LI Xu LIU Xiao-hui NIE Shao-ping DU Xin lu Qiang KANG Jun-ping DONG Jian-zeng GU Cheng-xiong HUANG Fang-jiong ZHOU Yu-jie CHEN Fang lu shu-zheng WU Xue-si MA Chang-sheng Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029China Department of Heart Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029China

Background C-reactive protein （CRP） is a lowly expressed marker for inflammatory response. This study aimed to evaluate the prognostic value of baseline CRP levels in patients undergoing coronary revascularization in the context of modern medical treatment. Methods This was a retrospective study in a single center. Four hundred and fourteen patients were enrolled, who underwent coronary revascularization and received adequate medication for secondary prevention of coronary heart disease. The study compared the follow-up clinical outcomes between high level CRP group （CRP 〉5 mg/L） and low level one. The median follow-up time was 551 days. Results Compared with low CRP group, the relative risk （RR） of the major adverse cardiovascular and cerebral events （MACCE） in high CRP group was 5.131 （95% CI： 1.864-14.123, P=0.002）. There were no significant differences in death myocardial infarction and stroke during the follow-up between two groups, but a higher risk of re-revascularization was found in high CRP group （RR 6.008, 95% CI： 1.667-21.665, P=0.006）. Cox regression analysis showed that only CRP level could contribute to MACCE during the follow-up. MACCE-free rate was much lower in high CRP group （Kaplan-Meier log-rank P 〈0.001）. Conclusion In the context of modern medical treatment, the baseline level of CRP is an independent predictor for long-term prognosis in patients with coronary revascularization.

关键词： C reactive protein coronary heart disease revascularization prognosis

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Clinical outcomes and cost-utility after sirolimus-eluting versus bare metal stent implantation

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Chinese Medical Journal 2010年第20期123卷 2797-2802页

作者： ZHAO Fu-hai lu shu-zheng LI Hui NING Shang-qiu YUAN Fei SONG Xian-tao JIN Ze-ning ZHOU Yuan CHEN Xin LIU Hong TIAN Rui MENG Kang LI Hong HAN Feng Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029

Background Randomized studies have shown beneficial effects of drug-eluting stent （DES） in reducing the risk of repeated revascularization. Other studies have shown higher proportion of death, myocardial infarction （MI） and increased cost concerning DES. However the long term safety and effectiveness of DES have been questioned recently.Methods To compare long term clinical outcomes, health-related quality of life （HRQOL） and cost-utility after sirolimus-eluting stent （SES） and bare metal stent （BMS） implantation in angina patients in China, 1241 patients undergoing percutaneous coronary revascularization （PCl） with either SES （n=632） or BMS （n=609） were enrolled continuously in this prospective, nonrandomized, multi-center registry study.Results Totally 1570 stents were implanted for 1334 lesions. Follow-up was completed in 1205 （97.1%） patients at 12 months. Rates of MI, all causes of death were similar between the two groups. Significant differences were found at rate of cardiovascular re-hospitalization （136 （22.4%） in BMS group vs. 68 （10.8%） in SES group, P=0.001） and recurrent angina （149 （24.5%） vs. 71 （11.3%）, P=0.001）. Dramatic difference was observed when compared the baseline and 9-month HRQOL scores intra-group （P 〈0.001）. However no significant difference was found inter-group either in baseline or follow-up HRQOL. Compared with SES, the total cost in BMS was significantly lower on discharge （62 546.0 vs. 78 245.0 Yuan, P=0.001）. And follow-up expenditure was remarkably higher in the BMS group than that in the SES group （13 412.0 vs. 8 812.0 Yuan, P=0.0001）.Conclusions There were no significant differences on death, in-stent thrombosis, MI irrespective of stent type. SES was superior to BMS on improvement of life quality. SES was with higher cost-utility compared to BMS.

关键词： sirolimus-eluting stent bare metal stent clinical outcomes cost-utility health-related quality of life

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Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction

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Chinese Medical Journal 2012年第6期125卷 1000-1004页

作者： XUE Zeng-ming LI Wei-ju MA Chang-sheng NIE Shao-ping DONG Jian-zeng LIU Xiao-hui KANG Jun-ping lu Qiang DU Xin WANG Xiao CHiN Fang ZHOU Yu-jie lu shu-zheng HUANG Fang-jiong GU Cheng-xiong WU Xue-si Department of Cardiology Beijing Anzhen Hospital Capital Medical university Beijing 100029 China Department of Cardiology Peking University Hospital Beijing 100873 China Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical university Beijing 100029 China

Background The optimal revascularization strategy in patients with heart failure with preserved ejection fraction （HFPEF） remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） in patients with HFPEF. Methods From July 2003 through September 2005, a total of 920 patients with coronary artery disease （CAD） and HFPEF （ejection fraction 〉50%） underwent PCI （n=350） or CABG （n=570）. We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events （MACCE）, including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days. Results In-hospital mortality was significantly lower in the PCI group than in the CABG group （0.3% vs. 2.5%, adjusted P=0.016）. During follow-up, there was no significant difference in the two groups with regard to mortality rates （2.3% vs. 3.5%, adjusted P=0.423）. Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG （13.4% vs. 4.0%, adjusted P 〈0.001）, mainly due to higher rate of repeat revascularization （adjusted P 〈0.001）. Independent predictors of mortality were age, New York Heart Association （NYHA） class and chronic total occlusion. Conclusion Among patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.

关键词： revascularization coronary artery disease heart failure

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