Objective To study the relationship between the levels of plasma fibrinogen, serum bilirubin, uric acid and mild stenosis of coronary artery. Methods Patients with suspected myocardial ischemia who underwent coronary angiography in our hospital were divided into the coronary artery mild stenosis group and the normal control group according to the result of coronary arteriongraphy between April 2007 to May 2009. Logistic regression was used to identify the risk factor of mild stenosis of coronary artery. Results Two-hundred and seventy-nine patients involving 191 patients with mild stenosis of coronary artery and 88 patients with normal coronary artery were included. The factors of gender, age, history of hypertension or diabetes mellitus, smoking history, systolic blood pressure, levels of plasma fibrinogen and serum creatinin were significantly different between the two groups. Multivariate logistic regression models found that the factors of age (OR=1.084, 95%CI 1.040 to 1.129, Plt;0.001), hypertension (OR=3.025, 95%CI 1.462 to 6.261, P=0.003), diabetes mellitus (OR=2.519, 95%CI 1.066 to 5.951, P=0.035), smoking history (OR=5.412, 95%CI 2.186 to 13.401, Plt;0.001), plasma fibrinogen (OR=1.748, 95%CI 1.059 to 2.885, P=0.029), serum bilirubin (OR=0.599, 95%CI 0.418 to 0.858, P=0.005), and high-density lipoprotein (HDL) cholesterol (OR=0.219, 95%CI 0.049 to 0.985, P=0.048) were independently associated with mild stenosis of coronary artery. By contrast, the level of serum uric acid was not associated with mild stenosis of coronary artery. Conclusion Except for traditional risk factors, levels of fibrinogen and bilirubin are independent risk factors of mild stenosis of coronary artery.
Objective To explore the correlation between hematocrit and slow coronary flow (SCF) in male patients. Methods We studied 205 patients with angiographically no more than one stenosis lt;40% in each major coronary artery who had admitted to the department of cardiology of the Beijing Anzhen Hospital Affiliated to Capital Medical University from August 2011 to August 2012. According to the level of hematocrit, 101 patients were classified into the trial group whose hematocrit was more 42.9%, while 104 patients into the control group whose hematocrit was no more than 42.9%. Clinical variables were analyzed and compared between the two groups. Results The age was younger in the trial group than the control group, whereas the levels of white blood cell count, mean platelet volume, triglyceride, low-density lipoprotein cholesterol, left anterior descending artery (LAD) and right coronary artery (RCA) TIMI frame count and the proportion of SCF in the LAD were higher in the trial group than in the control group (Plt;0.05). The results of correlation analysis showed that, LAD TIMI frame count (r=0.238, P=0.001), proportion of SCF in the LAD (r=0.206, P=0.003) and RCA TIMI frame count (r=0.209, P=0.003) were positively correlated with hematocrit. The results of multivariate analysis (using logistic regression with adjusted confounding factors such as age) showed that, LAD TIMI frame count (OR=1.031, 95%CI 1.006 to 1.056, P=0.014), proportion of SCF in the LAD (OR=1.919, 95%CI 1.038 to 3.547, P=0.038) were independently correlated with hematocrit. Conclusion The proportion of SCF in the LAD is independently correlated to hematocrit, which suggested that increased hematocrit may contribute to the pathophysiological change of SCF in male patients.
ObjectiveTo investigate the sex-specific impact of baseline myocardial injury on cardiac reverse remodeling after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS). MethodsThis retrospective cohort study consecutively enrolled patients with symptomatic severe AS who underwent TAVR between May 2021 and January 2024 at the Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University. According to the "Fourth Universal Definition of Myocardial Infarction (2018)", patients were classified into preprocedural myocardial injury-positive [hs-cTnI(+)] and -negative [hs-cTnI(?)] groups based on high-sensitivity cardiac troponin I (hs-cTnI) levels. Echocardiographic parameters were collected at baseline and at 1, 6, and 12 months after TAVR. Left ventricular mass index (LVMi) was used to evaluate the degree of cardiac reverse remodeling. Stratified by sex, the trends of LVMi at each postoperative timepoint were compared between sexes, and the impact of baseline myocardial injury on cardiac reverse remodeling within 12 months after TAVR was analyzed. ResultsA total of 408 patients were enrolled, with a median age of 72 (67, 77) years, including 227 (55.6%) males and 181 (44.4%) females. Preprocedural severe cardiac remodeling was observed in 81 patients, including 48 (21.1%, 48/227) male and 33 (18.2%, 33/181) female patients. Cardiac reverse remodeling in male patients occurred predominantly within the first 6 months after TAVR and subsequently plateaued between 6 and 12 months (P=0.528), whereas female patients showed continuous improvement in LVMi at each follow-up timepoint throughout the 12-month follow-up (P<0.05). There were 118 (52.0%) male and 100 (55.2%) female patients in the hs-cTnI (+) group. In both male and female subgroups, LVMi in the hs-cTnI (+) group was significantly higher than that in the hs-cTnI (?) group at baseline and each follow-up timepoint (P<0.05). ConclusionThe impact of baseline myocardial injury on post-TAVR cardiac reverse remodeling exhibits sex differences. Male patients in the hs-cTnI (+) group show poorer improvement in cardiac reverse remodeling, with a plateau phase at 6 months postoperatively, while female patients demonstrate sustained improvement in reverse remodeling within 12 months after TAVR.
Aortic stenosis (AS) is the most common primary valve lesion requiring surgery or transcatheter intervention in modern era. Its prevalence is rising rapidly as a consequence of the aging population. Transcatheter aortic valve replacement (TAVR) as a therapy option for older high-risk symptomatic severe AS patients has emerged and is currently extending its indications towards surgery intermediate- and low-risk subjects. Considering the common characteristics of frailty and high comorbidity among AS patients, cardiac rehabilitation (CR) has been proven to improve not only survival but also quality of life in previous reports. CR as a classⅠ recommendation in guidelines for the prevention and treatment of cardiovascular disease has been widely used in clinical practice. The purpose of this article is to sort out the current CR programs for TAVR patients in global medical management, and explore the CR optimization program fit for China medical model in post COVID-19 pandemic era.