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Depression and myocardial injury in ST-segment elevation myocardial infarction:A cardiac magnetic resonance imaging study

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World Journal of Clinical Cases 2020年第7期8卷 1232-1240页

作者： Zhao-Qing Sun Tong-Tong Yu Yue Ma Quan-Mei Ma Yun-Di Jiao Dong-Xu He Jia-KeWu Zong-Yu Wen Xiao-Nan Wang Yang Hou Zhi-Jun Sun Department of Cardiology Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Radiology Shenyang 110004Liaoning ProvinceChina

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(stEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with stEMI.METHODS A total of 107 stEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with stEMI undergoing PCI,depression was independently associated with a large infarction size.

关键词： Depression Patient Health Questionnaire-9 Myocardial injury ST-segment elevation myocardial infarction Cardiac magnetic resonance

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The relation between serum phosphorus levels and long-term mortality in Chinese patients with ST-segment elevation myocardial infarction

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Journal of Geriatric Cardiology 2019年第10期16卷 775-781页

作者： Guo-Hua ZHU Xi-Peng SUN Zhi LIU Zhen-Xing FAN Yan-Ling WANG Jing TAN Jing LI Qi HUA Department of Cardiology Xuanwu Hospital Capital Medical University

Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortality in Chinese patients with ST-segment elevation myocardial infarction (stEMI) who had preserved renal function at baseline. Methods We enrolled patients with stEMI who had preserved renal function at baseline in Xuanwu Hospital from January 2011 to December 2016. Those patients were divided into four groups based on serum phosphorus levels. All-cause mortality rates were compared between groups. Mean duration of follow up was 54.6 months. We used Cox proportional-hazards models to examine the relation between serum phosphorus levels and all-cause mortality after adjustment for potential confounders. Results 1989 patients were involved and 211 patients (10.6%) died during follow-up. Based on serum phosphorus levels, patients were categorized into the following groups: 4.50 mg/dL (n = 162), respectively. The lowest mortality occurred in patients with serum phosphorus levels between 2.51–3.50 mg/dL, with a multivariable-adjusted hazard ratio of 1.19 (95% CI: 0.64–1.54), 1.37 (95% CI: 1.22–1.74), and 1.46 (95% CI: 1.35–1.83) in patients with serum phosphorus levels of 4.50 mg/dL, respectively. Conclusions Elevated serum phosphorus levels were associated with all-cause mortality in Chinese patients with stEMI who had preserved renal function at baseline.

关键词： Mortality Serum phosphorus levels ST-segment elevation myocardial infarction

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Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction

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Chinese Medical Journal 2019年第9期132卷 1028-1036页

作者： Jin Si Xue-Wen Li Yang Wang Ying-Hua Zhang Qing-Qing Wu Lei-Min Zhang Xue-Bing Zuo Jing Gao Jing Li Department of Cardiology Xuanwu HospitalCapital Medical UniversityBeijing 100053China Department of Cardiology Tianjin Medical UniversityTianjin 300070China Cadre's Ward Characteristic Medical Center of Chinese People's Armed Police ForceTianjin 300162China Medical Research & Biometrics Center National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Cardiology Beijing Luhe HospitalCapital Medical UniversityBeijing 101149China Department of Cardiology Qinghe Substation Hospital of Beijing Municipal Administration of PrisonsTianjin 300481China

Background:The mortality of cardiovascular disease is constantly rising,and novel biomarkers help us predict residual risk.This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (stEMI).Methods:The 419 consecutive patients with stEMI,treated at one medical center,from March 2010 to December 2015 were retrospectively investigated.Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay.The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups.Short- and long-term outcomes were compared,as were age-based subgroups (patients aged 60 years and younger vs.those older than 60 years).statistical analyses were mainly conducted by student t-test,Chi-squared test,logistic regression,and Cox proportional-hazards regression.Results:The H-HCY group had more males (84.6% vs.75.4%,P=0.018),and a lower prevalence of diabetes (20.2% vs.35.5%,Pstory of hypertension (hazard ratio [HR]:1.881,95% confidence interval [CI]:1.178–3.005,P=0.008) and higher Killip class (HR:1.923,95% CI:1.419–2.607,PstEMI;however,among elderly patients with stEMI,this study revealed a risk

关键词： Homocysteine Acute ST-segment elevation myocardial infarction Percutaneous coronary intervention Clinical outcome

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De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

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World Journal of Clinical Cases 2019年第20期7卷 3296-3302页

作者： Yang-Yi Lin Yu-Dan Wen Guo-Lin Wu Xiang-Dong Xu Department of Cardiology Jiading District Central Hospital Affiliated Shanghai University of Medical and Health SciencesShanghai 201800China Department of Electrocardiology the Third Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325200Zhejiang ProvinceChina

BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min.The first ECG showed only T-wave inversion in III and aVF leads.Another ECG was performed at the 100th minute,showing upsloping st segments depressed with tall and symmetrical T waves in the precordial leads;the J point was raised by 0.1 mV at the aVR lead.The patient was referred to our catheterization laboratory.A third ECG showed st segment elevation by 0.2 mV in the I and aVL leads.The patient underwent emergency coronary angiography,which revealed complete proximal left anterior descending coronary(LAD)occlusion.The second patient presented with a 1-h history of sudden-onset,severe,substernal crushing chest pain.The first ECG showed stsegment elevation(0.1–1.7 mV)in I,aVL,and precordial leads.The patient was referred to the catheterization laboratory.On arrival,his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back.The third ECG showed a typical de Winter pattern.Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic,and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.

关键词： De Winter syndrome ST-segment upsloping depression Dynamic Case report

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New debate of revascularization strategy of non-infarct-related artery lesions in patients with ST-segment elevation myocardial infarction and cardiogenic shock:decoding the CULPRIT-SHOCK trial,not enough to challenge the current guidelines

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Chinese Medical Journal 2019年第5期132卷 613-615页

作者： Fang Song Qiang Wu Xiao-Ping Chen West China School of Medicine Sichuan UniversityChengduSichuan 610041China Department of Cardiology Guizhou Provincial People's HospitalGuiyangGuizhou 550002China Medical College of Guizhou University GuiyangGuizhou 550025China Department of Cardiology West China HospitalSichuan UniversityChengduSichuan 610041China

To the Editor: Research result of CULPRIT-SHOCK trial[1] presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2017 conference suggested that acute myocardial infarction (AMI) patients with multivessel disease (MVD) and cardiogenic shock undergoing primary percutaneous coronary interventions (PCI) treated with culprit-only revascularization (COR) strategy had lower mortality at one month compared with immediate complete revascularization in single procedure (CRS) strategy, which challenge current guidelines and years of consensus[2-5].

关键词： revascularization strategy non-infarct-related artery lesions ST-segment elevation myocardial infarction

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Clinical study on the effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

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Journal of Hainan Medical University 2017年第13期23卷 75-78页

作者： Qun-Xiong Fan Ji-Xian Zhao Huan-Xin Zhang Bo Li Zheng-Rong Li Department of Cardiology Affiliated People's Hospital of Hubei Medical CollegeWuhan 432000China ICU Affiliated People's Hospital of Hubei Medical CollegeWuhan 432000China

Objective:To investigate the clinical effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention.Method: From March 2014 to September 2016, we selected 190 patients with ST-segment elevation myocardial infarction with percutaneous coronary intervention, according to the admission time is divided into observation group and control group, the control group was treated with conventional therapy (aspirin, isosorbide dinitrate, metoprolol tartrate, clopidogrel sulfate, captopril, atorvastatin calcium and diuretics) and trimetazidine, observation group in the control group based on Tongxinluo combined treatment, each group of 95 cases, and hs-CRP, aldosterone, NT-proBNP, TNF-α, IL-6, and cardiac function (LVEDV,LVESV,LVEF,SV) were compared.Result: The Hs-CRP in the observation group was significantly lower than that in the control group;The aldosterone in the observation group was significantly lower than that in the control group;The levels of NT-proBNP, TNF-α and IL-6 in the observation group were significantly lower than those in the control group;LVVEV and LVESV were significantly lower in the observation group than in the control group, LVEF and SV were significantly higher than those in the control group.Conclusion:Tongxinluo combined with trimetazidine in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention in patients with clinical effect is better, stable plaque, effectively improve microcirculation and cardiac function, recommended a wide range of clinical application.

关键词： Tongxinluo Trimetazidine Acute ST-segment elevation myocardial infarction Percutaneous coronary intervention Cardiac function

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Effect of continuous positive airway pressure ventilation on nocturnal ST-segment changes in patients with sleep-disordered breathing

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Journal of Geriatric Cardiology 2007年第2期4卷 101-104页

作者： Wenli Zhang Shiwen Wang Rui Chen Mohan Liu Lin Wang Lei Gao Caiyi Lu Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China Institute of Geriatric Cardiology Chinese PLA General Hospital Beijing 100853 China

Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. st depression was defined as a st segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of st depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed st segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of st depression than when st segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with st depression, the duration of st depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (Pst depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ Tst), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ Tst from 50.6±21.4 to 12.9±14.7% (PST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of st depression. st depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.

关键词： ST-segment depression myocardial ischemia sleep-disordered breathing continuous positive airway pressure

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Value of fibrinogen to albumin ratio on predicting spontaneous recanalization of infarct-related artery in patients with acute ST-segment elevation myocardial infarctionl

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China Medical Abstracts(Internal Medicine) 2019年第2期36卷 88-89页

作者：赵一品 Dept Cardiol 2nd Affil HospZhengzhou Univ

Objective To investigate the value of fibrinogen toalbumin ratio (FAR) at admission on predicting spontaneousrecanalization of infarct-related artery ( IRA) inpatients with acute ST-segment elevation myocardial infarction( stEMI ). Methods Clinical data from 255acute stEMI patients ((61. 1 ± 11. 2) years old,189males) who underwent emergency coronary angiographywithin 12 hours in our hospital from December 2015 toApril 2018 were retrospectively analyzed. The acutestEMI patients were divided into non-spontaneous recanalizationgroup ( thrombolysis in myocardial infarction(TIMI) flow grade 0 - 1,203 cases) and spontaneousrecanalization group (TIMI flow grade 2 - 3,52 cases).Multivariate logistic regression analysis was used to evaluaterelated factors of IRA spontaneous recanalization.The receiver operating characteristic (ROC) curve wasused to evaluate the value of FAR in predicting spontaneouscoronary recanalization.

关键词： stEMI albumin ratio acute ST-segment elevation myocardial infarctionl IRA

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Perspective of delay in door-to-balloon time among Asian population

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Journal of Geriatric Cardiology 2018年第12期15卷 732-737页

作者： Long LI Man-Yan WU Feng ZHANG Su-Fang LI Yu-Xia CUI Dan HU Hong CHEN Department of Cardiology Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial InfarctionCenter for Cardiovascular Translational ResearchPeking University People's HospitalBeijingChina

1 Introduction Effective and timely reperfusion of infarcted coronary artery is crucial to the treatment of patients with ST-segment elevation myocardial infarction(stEMI).[1,2]Current guidelines highly recommend that the door-to-balloon(D2B)time,as a quality metric of primary percutaneous coronary intervention(PCI)in patients with stEMI,should be≤90 min and preferably less than 60 min.[3,4]However,significant variations from guidelines exist in the real world practices at hospitals.

关键词： Door-to-balloon time Primary percutaneous coronary intervention ST-segment elevation myocardial infarction Written consent

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Significance of lead aVR in acute coronary syndrome

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World Journal of Cardiology 2014年第7期6卷 630-637页

作者： Akira Tamura Department of Cardiology and Clinical Examination Oita University

The 12-lead electrocardiogram(ECG)is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome(ACS).Unlike other 11 leads,lead aVR has been long neglected until recent years.However,recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS.ST-segment elevation in lead aVR can be caused by(1)transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery;(2)transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery;and(3)reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads.On the other hand,ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions.It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction.Cardiologists should pay more attention to the tracing of lead aVR when interpreting the12-lead ECG in clinical practice.

关键词： Electrocardiography Lead aVR ST-segment T wave Acute coronary syndrome

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