ObjectiveTo investigate the association of arterial stiffness with cardiovascular risk factors. MethodsFrom July 2014 to August 2015, 1 599 participants aged over 65 years old were recruited from 10 communities located in the northern Shanghai. Carotid-femoral pulse wave velocity (cf-PWV) was measured by SphygmoCor device. Cardiovascular risk factors were assessed by questionnaire, anthropometry or conventional biochemical measurements. SPSS 20.0 was applied for data management and statistical analysis. ResultsCf-PWV was significantly associated with cardiovascular risk factors (P<0.001). Moreover, with the accumulating cardiovascular risk factors, cf-PWV increased gradually and significantly (P<0.001). The increasing trend remained significant in all participants, in men and in women, respectively. ConclusionArterial stiffness is significantly associated with cardiovascular risk factors and their accumulation.
Objective To introduce a novel approach using parallel placement of another oxygenator in the recirculation line as oxygen supply for oxygenator failure without circulatory arrest in cardiopulmonary bypass （CPB），and confirm its outcomes in an animal experiment. Methods A traditional piglet CPB model was established. Oxygenator failure model was established by reducing fraction of inspired oxygen （FiO2） from 80% to 21% after aortic cross-clamp and cardiac arrest in CPB. Another oxygenator was then parallel placed in the recirculation line to supply 100% oxygen.Dynamic changes in partial pressure of oxygen （PaO2），mixed venous oxygen saturation （SvO2），arterial oxygen saturation（SaO2） and blood pH of blood samples from the arterial perfusion duct were monitored with different blood flow of400 ml/min，800 ml/min and 1 100 ml/min. Results When FiO2 was reduced to 21%，PaO2 decreased to 64-67 mm Hg（P＜0.001），SaO2 decreased significantly to 88%-90% （P＜0.001），SvO2 decreased to 69%-72% （P＜0.001），and blood pH decreased too，all indicating oxygenator failure. After parallel placement of another oxygenator in the recirculation line was performed，PaO2，SaO2 and SvO2 all significantly increased，as well as blood pH. When the blood flow in the recirculation line achieved 33% or above of overall arterial perfusion flow，clinical oxygen demand was generally satisfied. Conclusion Parallel placement of another oxygenator in the recirculation line may be utilized as a treatment strategy for oxygenator failure without circulatory arrest and changeover of failed oxygenator.
ObjectiveTo explore the causal association between venous thromboembolism (VTE) and cardiovascular disease (CVD) risks using a two-sample bidirectional Mendelian randomization (MR) study. MethodsThe single-nucleotide polymorphism (SNP) data associated with VTE and CVD from genome-wide association studies were obtained as instrumental variables. Inverse variance weighted (IVW) was used as the main MR method and other methods were used as supplementary methods. Cochran's Q test, the intercept term of MR-Egger, and MR-PRESSO were used to assess pleiotropy and heterogeneity to ensure the robustness of the results. ResultsThe IVW method suggested a causal association between VTE and atrial fibrillation (OR=1.033, 95%CI 1.009 to 1.058, P=0.008), but no association was identified between VTE and coronary artery disease (OR=0.994, 95%CI 0.974 to 1.023, P = 0.551), heart failure (OR=1.021, 95%CI 0.992 to 1.050, P=0.159) and myocardial infarction (OR=1.012, 95%CI 0.971 to 1.055, P=0.568). The results of Cochran's Q test showed that there was no heterogeneity in the MR analyses of VTE and CVD. The MR-Egger intercept analysis and the MR-PRESSO global testing did not detect potential horizontal pleiotropy, and the results were robust. Reverse MR analysis was used to verify the presence of reverse causal associations. The reverse MR analysis demonstrated that reverse causal associations between VTE and CVD were not evidenced. ConclusionThe results of the MR study demonstrated a causal association between VTE and atrial fibrillation, but not with coronary artery disease, heart failure or myocardial infarction.
ObjectivesTo systematically review the safety and efficacy of aspirin in primary prevention of cardiovascular diseases.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of aspirin for primary prevention of cardiovascular diseases from inception to November 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 13 RCTs involving 164 225 participants were included. The results of meta-analysis showed that: aspirin reduced the risk of myocardial infarction (RR=0.85, 95%CI 0.75 to 0.97, P=0.01), ischemic stroke (RR=0.86, 95%CI 0.79 to 0.95, P=0.002) and risk of major adverse cardiovascular events (RR=0.90, 95%CI 0.86 to 0.94, P<0.000 1). However, all-cause mortality (RR=0.97, 95%CI 0.93 to 1.02, P=0.22) and cardiovascular mortality (RR=0.93, 95%CI 0.85 to 1.02, P=0.11) were not reduced. Additionally, it increased risk of hemorrhagic stroke (RR=1.29, 95%CI 1.02 to 1.64, P=0.03), major bleeding (RR=1.43, 95%CI 1.31 to 1.56, P<0.000 01) and gastrointestinal bleeding (RR=1.59, 95%CI 1.33 to 1.90, P<0.000 01).ConclusionCurrent evidence shows that aspirin can reduce the incidence of major adverse cardiovascular events and myocardial infarction during primary prevention of cardiovascular disease, while increase the risk of bleeding, especially gastrointestinal bleeding. Therefore, its potential benefits may be offset. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Cardiopulmonary bypass(CPB) is associated with thrombocytopenia and platelet dysfunction. The primary cause of acquired platelet defect is thought to be activation and release of alpha granules during CPB. Before CPB, platelet-rich plasma (PRP) was prepared by obtaining the required amount of patient’s whole blood by autologous plateletpheresis. PRP could be reinfused after operation in order to protect the function and quantities of the platelets. On the other hand, PRP could be made into autologous platelet gel (APG). APG contains supraphysiologic amounts of growth factors, and has adequate tensile strength and adhesive ability. Therefore, it can be used for hemostasis in operation, sealing wound and enhancing incision or dehiscent sternal wounds healing.
ObjectiveTo investigate the correlation between lipid accumulation product (LAP) and risk of ischemic cardiovascular disease (ICVD). MethodsThis cross-sectional study was performed among community residents from an urban community in Chengdu area between September 2011 and June 2012. Questionnaire survey was carried out. Each individual underwent biochemistry analysis and physical examination. In addition, brachial-ankle pulse wave velocity (BaPWV) and augmentation index (AI) were detected. Pearson correlation analysis was performed to explore the relationship between LAP and each cardiovascular risk factor. Liner regression model was used to analyze the relationship between LAP and ICVD. ResultsA total of 780 individuals with complete data were included in the analysis. LAP was correlated with blood pressure, total cholesterol, high density lipoprotein cholesterol, fasting blood glucose, and BaPWV (P＜0.05). LAP was associated with the risk of ICVD (r=0.253, P＜0.001). After being adjusted with sex, age and other cardiovascular risk factors, LAP was also correlated with the risk of ICVD (r=0.050, P＜0.001). ConclusionsHigh LAP is associated with elevated cardiovascular risks and subclinical vascular damage. In addition, LAP is correlated with ICVD risk, thus it may be used to predict the incidence of ICVD to some extent. However, as the correlation is weak, our study does not support the direct use of this indicator to predict ICVD. Large-sample studies based on different races and ages are needed.
Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Heart sound classification plays a key role in the early detection of CVD. The difference between normal and abnormal heart sounds is not obvious. In this paper, in order to improve the accuracy of the heart sound classification model, we propose a heart sound feature extraction method based on bispectral analysis and combine it with convolutional neural network (CNN) to classify heart sounds. The model can effectively suppress Gaussian noise by using bispectral analysis and can effectively extract the features of heart sound signals without relying on the accurate segmentation of heart sound signals. At the same time, the model combines with the strong classification performance of convolutional neural network and finally achieves the accurate classification of heart sound. According to the experimental results, the proposed algorithm achieves 0.910, 0.884 and 0.940 in terms of accuracy, sensitivity and specificity under the same data and experimental conditions, respectively. Compared with other heart sound classification algorithms, the proposed algorithm shows a significant improvement and strong robustness and generalization ability, so it is expected to be applied to the auxiliary detection of congenital heart disease.
Cardiovascular disease is the leading cause of death worldwide, accounting for 48.0% of all deaths in Europe and 34.3% in the United States. Studies have shown that arterial stiffness takes precedence over vascular structural changes and is therefore considered to be an independent predictor of many cardiovascular diseases. At the same time, the characteristics of Korotkoff signal is related to vascular compliance. The purpose of this study is to explore the feasibility of detecting vascular stiffness based on the characteristics of Korotkoff signal. First, the Korotkoff signals of normal and stiff vessels were collected and preprocessed. Then the scattering features of Korotkoff signal were extracted by wavelet scattering network. Next, the long short-term memory (LSTM) network was established as a classification model to classify the normal and stiff vessels according to the scattering features. Finally, the performance of the classification model was evaluated by some parameters, such as accuracy, sensitivity, and specificity. In this study, 97 cases of Korotkoff signal were collected, including 47 cases from normal vessels and 50 cases from stiff vessels, which were divided into training set and test set according to the ratio of 8 : 2. The accuracy, sensitivity and specificity of the final classification model was 86.4%, 92.3% and 77.8%, respectively. At present, non-invasive screening method for vascular stiffness is very limited. The results of this study show that the characteristics of Korotkoff signal are affected by vascular compliance, and it is feasible to use the characteristics of Korotkoff signal to detect vascular stiffness. This study might be providing a new idea for non-invasive detection of vascular stiffness.
The main cause of death in patients with end-stage renal disease (ESRD) is cardiovascular disease, and trimethylamine-N-oxide (TMAO) has been found to be one of the specific risk factors in the pathogenic process in recent years. TMAO is derived from intestinal bacterial metabolism of dietary choline, carnitine and other substances and subsequently catalyzed by flavin monooxygenase enzymes in the liver. The changes of intestinal bacteria in ESRD patients have contributed to the accumulation of gut-derived uremic toxins such as TMAO, indoxyl sulfate and indole-3-acetic acid. While elevated TMAO concentration accelerates atherosclerosis through mechanisms such as inflammation, increased scavenger receptor expression, and inhibition of reverse cholesterol transport. In this review, this research introduces the biological function, metabolic processes of TMAO and mechanisms by which TMAO promotes the progression of cardiovascular disease in ESRD patients and summarizes current interventions that may be used to reverse gut microbiota disturbances, such as activated carbon, fecal microbial transplantation, dietary improvement, probiotic and probiotic introduction. It also focuses on exploring intervention targets to reduce the gut-derived uremic toxin TMAO in order to explore the possibility of more cardiovascular disease treatments for ESRD patients.
Objective To observe and analysis the features of images of fundus fluorescein angriography (FFA) in low-perfused retinopathy caused by cephalo-cervical peripheral vascular stenosis or occlusion. Methods The results of FFA of 27 patients diagnosed with carotid artery stenosis or occlusion by digital subtraction angiography (DSA) and examination of Doppler and vascular-pulsation were retrospectively analyzed. Result All of the patients had a delayed arm-retinal circulation duration from 20.0 to 81.08 seconds with the mean of 32.1 seconds; a delayed retinal arteriovenous filling duration from 6 to 64.0 seconds with the mean of 24.2 seconds. Delayed arm-retinal circulation duration and retinal a rteriovenous filling duration in 10 cases (37.0%); microangioma, vascular wall staining, nonperfused capillary area in 11 (40.7%); and anterior ischemic syndrome in 6 (22.2%) were found. In the 6 patients with anterior ischemic syndrome, 4 cases had narrow retinal artery, segmental changes of blood stream, vascular atresia, and abnormal arterio-venous anastomosis, and 2 cases had bold vascular loops. Conclusions The main manifestations of FFA in patients with low-perfused retinopathy are malperfusion and retinal ischemia, whose degrees relate to the extend of carotid artery stenosis or atresia, and the process of the disease.Serious retinal ischemia may combined with anterior ischemic syndrome. (Chin J Ocul Fundus Dis，2004，20：84-86)