Hong Lin

Subclinical endothelial dysfunction and low‐grade inflammation play roles in the development of erectile dysfunction in young men with low risk of coronary heart disease

The purpose of this study is to investigate the possible underlying pathogenesis of erectile dysfunction(ED) in young men with low risk of coronary heart disease and no well-known aetiology. To conduct this study, 122 patients with ED under the age of 40 were enrolled, along with 33 age-matched normal control subjects. The patients with ED had significantly higher levels of systolic blood pressure (SBP), total cholesterol and triglyceride, high sensitivity C-reactive protein (hs-CRP), greater carotid intima-media thickness (CIMT) and Framingham risk score (FRS) than the control group, though all of these values were within the respective normal range. Further, the brachial artery flow- mediated vasodilation (FMD) values were significantly lower in ED patients and correlated positively with the severity of ED (r = 0.714, p < 0.001). When these significant factors were studied in the multivariate logistic regression model, FMD, SBP, hs-CRP and FRS remained the statistical significance. The receiver-operating characteristic (ROC) analysis demonstrated that FMD had a high ability to predict ED in young male with low FRS [area under the curve (AUC) 0.921, p < 0.001]. The cutoff value of FMD <10.25% had sensitivity of 82.8% and specificity of 100% for diagnosis of ED. FRS and hs- CRP were also proven to be predictors of ED (AUC 0.812, p < 0.001; AUC 0.645, p = 0.011, respectively). The results of this study validated that subclinical endothelial dysfunction and low-grade inflammation may be the underlying pathogenesis of ED with no well-known aetiology. Young patients complaining of ED should be screened for cardiovascular risk factors and possible subclinical atherosclerosis. Measurement of FMD, hs-CRP and FRS can improve our ability to predict and treat ED, as well as subclinical cardiovascular disease early for young male.

Sex Differences Between Vascular Endothelial Function and Carotid Intima-Media Thickness by Framingham Risk Score

To investigate sex differences associated with changes in brachial artery flow‐mediated dilatation and carotid intima‐media thickness by Framingham Risk Score.

Erectile dysfunction is associated with subclinical carotid vascular disease in young men lacking widely-known risk factors

This study aimed to gain insight into the underlying pathogenesis of erectile dysfunction in young men under the age of 40 years without widely-known risk factors. Compared with normal controls, patients with erectile dysfunction had increased carotid intima–media thickness, fasting levels of blood glucose and insulin, and homeostatic model assessment index, as well as lower flow-mediated vasodilation and testosterone levels (P < 0.05), though all of these values were within their respective normal range. Multivariate logistic regression analysis identified carotid intima–media thickness, flow-mediated vasodilation, insulin level, and homeostatic model assessment index as significant predictors of erectile dysfunction. Young men with flow-mediated vasodilation <10.65% were 11.645 times more likely to have erectile dysfunction, young men with carotid intima–media thickness >0.623 mm had a 4.16-fold, and young men with homeostatic model assessment index >1.614 had a 5.993-fold greater risk of having erectile dysfunction. In conclusions, in young men with normal results from general clinical screening, an increased carotid intima–media thickness and homeostatic model assessment index and reduced flow-mediated vasodilation were associated with a higher incidence of erectile dysfunction. Erectile dysfunction may appear before the detection of traditional cardiovascular risk factors and may be the earliest clinical sign of subclinical cardiovascular disease.

High Serum Phosphorus Level Is Associated with Left Ventricular Diastolic Dysfunction in Peritoneal Dialysis Patients

Objectives We initiated this study to explore the relationships of serum phosphorus level with left ventricular ultrasound features and diastolic function in peritoneal dialysis (PD) patients. Methods 174 patients with end-stage renal disease (ESRD) receiving PD were enrolled in this retrospective observational study. Conventional echocardiography examination and tissue Doppler imaging (TDI) were performed in each patient. Clinical information and laboratory data were also collected. Analyses of echocardiographic features were performed according to phosphorus quartiles groups. And multivariate regression models were used to determine the association between serum phosphorus and Left ventricular diastolic dysfunction (LVDD). Results With the increase of serum phosphorus levels, patients on PD showed an increased tissue Doppler-derived E/e’ ratio of lateral wall (P < 0.001), indicating a deterioration of left ventricular diastolic function. Steady growths of left atrium and left ventricular diameters as well as increase of left ventricular muscle mass were also observed across the increasing quartiles of phosphorus, while left ventricular ejection fraction remained normal. In a multivariate analysis, the regression coefficient for E/e’ ratio in the highest phosphorus quartile was almost threefold higher relative to those in the lowest quartile group. And compared with patients in the lowest phosphorus quartile (<1.34 mmol/L) those in the highest phosphorus quartile (>1.95 mmol/L) had a more than fivefold increased odds of E/e’ ratio >15. Conclusions Our study showed an early impairment of left ventricular diastolic function in peritoneal dialysis patients. High serum phosphorus level was independently associated with greater risk of LVDD in these patients. Whether serum phosphorus will be a useful target for prevention or improvement of LVDD remains to be proved by further studies.

Left atrial diameter is associated with target organ damage in patients with type 2 diabetes mellitus

This paper aims to investigate whether there is a relationship between left atrial diameter (LAD) and target organ damage (TOD) in patients with type 2 diabetes mellitus (DM). Two-hundred-and-eleven patients with type 2 DM were recruited. Data on left ventricular mass index (LVMI), diabetic retinopathy, carotid intima–media thickness/carotid plaque, micro-albuminuria, and serum creatinine levels were collected to determine whether TOD occurred in patients with type 2 DM. Age, body mass index, waist-hip ratio, a history of DM, Framingham Score, and 10-year risk were used to assess cardiovascular disease risk. Patients were divided into four groups: zero TOD (group I, n = 50), one TOD marker (group II, n = 76), two TOD markers (group III, n = 51), and at least three TOD markers (group IV, n = 34). Using multivariate regression analyses, age, body mass index, waist-hip ratio, a history of DM, Framingham Score, and 10-year risk were significantly associated with LAD. LAD was associated with an increased number of markers for TOD. Univariate analyses demonstrated significant relationships between LAD and TOD in the context of serum creatinine and urinary albumin creatinine ratio (r = 0.292, p < 0.001), creatinine (r = 0.346, p < 0.001), carotid intima–media thickness (r = 0.128, p = 0.032), and LVMI (r = 0.399, p < 0.001). Multivariate regression analyses also determined that LVMI and creatinine were independent predictors of LAD enlargement. LAD may be associated with cardiovascular disease risk. LAD enlargement could be an effective indicator of TOD, particularly renal impairment and left ventricular hypertrophy. Screening for LAD may offer a new and rapid approach for evaluating the severity of DM.

GW24-e1282 A noninvasive sizing method to choose fitted atrial septal defect occluder by transthoracic echocardiography in adults with secundum atrial septal defects

Objectives In our clinical practice, we try to find a feasible method to size the hole of ASD by only 2D transthoracic echocardiography (2D-TTE). It should be more practical, less expensive and without pain. Methods Sixty-seven consecutive adult patients (26 males, 41 females, mean age 38.4 ± 8.5 years) were scheduled to have ASD device closure. Before that, we calculated the size of ASD by 2D transthoracic echocardiography (2D-TTE) through parasternal four chambers view, parasternal short axes view, apical four chambers view, subcostal four chambers view and subcostal two chambers view. The biggest size from the views would be chosen for ASD device closure. Meanwhile, we paid attention to the ASD margins, and we divided them to floppy margin group (n = 24) and firm margin group (n = 43). For the floppy margin patients, we would add 2 or 4 mm more than the 2D-TTE size for preparing ASD device size. And for the firm margin patient, we chose the same 2D-TTE size for ASD device size. Results The total successful ASD device closure rate was 94.0% (63/67). The average total trans-catheter ASD closure time was 42.3 ± 12.5 minutes. ASD device closure succeeded at the first time was: 40/43 (93.0%) in the firm margin group; 16/24 (66.7%) in the floppy margin group. For the rest patient whose ASD couldn’t be closed at the first time, we reduced the size 2–5 mm in the firm margin group, the rest 3 all got successful ASD device closed. As in the floppy margin group, there were 4 patients needed adding 4–6 mm to the 2D-TTE size and then their ASD device closed successfully. There were only 4 patients (6%) in floppy margin group couldn’t be ASD device closed. For average 1.4 years follow up, only 6 patients (9.5%) had some chest pain complain, but all the devices were stable. Conclusions With our experience, the sizing based on 2D-TTE could be used for ASD device selection. The multiple views of TTE should be used to calculate the biggest size of ASD. And the margins of the ASD hole also need to be considered.

GW24-e2277 Cardiac Diastolic Dysfunction may Hold Promise as Markers of Cardiotoxicity during Daunorubicin Treatment in Acute Nonlymphocytic Leukemia Patients

Objectives Daunorubicin causes cardiac injury in acute nonlymphocytic leukemia. Early identifying caridotoxicity induced by daunorubicin might help individualise cardiac protect treatment. Dexrazoxane can reduce cardiac damage. In this study, we assess the left ventricular function in patients with acute nonlymphocytic leukemia who had daunorubicin treatment with or without in combination with dexrazoxane. Methods Patients with acute nonlymphocytic leukemia, undergoing three-cycle chemotherapy regimen, were randomly assigned to receive daunorubicin alone (n = 22) or daunorubicin with dexrazoxane (n = 20). Echocardiograms and serial measurements of cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP) were obtained before, during and after treatment. Results There were no significant differences in left ventricle ejection faction (LVEF), diastolic mitral wave ratio E/A throughout all phases of the treatment between two groups. Tissue Doppler index e’/a’ in daunorubicin group before treatment was 1.08 ± 0.05 and 0.98 ± 0.24 after treatment (P = 0.04), however, in daunorubicin-dexrazoxane group was 1.11 ± 0.07 to 1.09 ± 0.10 (P = 0.57). Tei index in daunorubicin group before treatment was 0.32 ± 0.03 and 0.49 ± 0.11 after treatment (P = 0.001), in daunorubicin-dexrazoxane group was 0.33 ± 0.03 to 0.34 ± 0.04 (P = 0.07). After treatment, cTnT levels were increased 52% in daunorubicin group and 14% in doxorubicin-dexrazoxane group, (P = 0.003). NT-proBNP levels were increased 48% and 16%, respectively, after treatment (P = 0.04). The percentage of hsCRP levels did not differ between groups at any time. During the treatment, e’/a’, Tei index were associated with abnormally increased cTnT and NT-proBNP levels (P <0.05). Conclusions Cardiac diastolic dysfunction index e’/a’ and Tei index showed better performance in the group received dexrazoxane, and they were related to abnormal changes in cardiac biomarkers too. It shows that e’/a’ and Tei index would be potential applicable markers for detecting early daunorubicin–induced cardiac damage.

GENDER DIFFERENCES IN VASCULAR ENDOTHELIAL FUNCTION AND CAROTID INTIMA MEDIA THICKNESS BY FRAMINGHAM RISK SCORE

Objectives Vascular dysfunction is associated with increased risk for adverse cardiovascular events. However, less is known about gender differences in endothelial function and arterial intima thickness according to Framingham risk score. The purpose of this study is to investigate whether the gender differences are existed in flow-mediated vasodilation and carotid intima thickness by Framingham risk score (FRS). Methods According to the Framingham risk score, 1083 subjects (544 males and 539 females) were divided into three groups: low-risk, middle risk and high-risk group respectively. Brachial arterial flow-mediated vasodilation (FMD) and carotid intima media thickness (IMT) were measured by high frequency ultrasound. Results With the increasing of the Framingham risk score, FMD reduced and carotid IMT increased in both genders (p<0.001). Compared with males, FMD of females were significantly higher in the low-risk FRS group (female to male: 9.76±3.62% vs 8.31±2.89%, p<0.001). However, FMD of females were significantly lower than males in the mid-risk and the high risk group (female to male: 6.67±2.42% vs 7.43±2.65%, 5.78±2.39% vs 6.41±2.27%, respectively, p<0.001. But there are no significant gender differences in carotid IMT among the three groups. Conclusions Gender differences are existed in FMD not in carotid IMT according to the Framingham risk score. FMD is more sensitive than IMT to response the gender difference in vascular function under Framingham risk stratification.

Subclinical endothelial dysfunction and low-grade inflammation play roles in the development of erectile dysfunction in young man with low risk of coronary heart disease

Introduction and Objectives There is a close relationship between erectile dysfunction (ED) and cardiovascular disease. However, many young patients presenting with ED do not have clinical cardiovascular disease and even other well-known causes. We aimed to investigate the underlying pathogenesis of ED without known aetiology in young man with low risk of coronary heart disease. Methods One hundred and twenty two patients and 33 normal controls under the age of 40 years were enrolled. Risk factors for coronary artery disease, endothelial function as measured by the endothelium-dependent flow-mediated dilation (FMD), and ED severity as measured by the International Index of Erectile Function-5 (IIEF-5) score was examined. Results Although the values were all in the normal range, systolic blood pressure (SBP), total cholesterol and triglyceride, high sensitivity C-reactive protein (hs-CRP), carotid intima-media thickness (CIMT) and Framingham risk score (FRS) were significantly higher in patients with ED compared to the controls. FMD values were significantly lower in ED patients and correlated positively with the severity of ED (r=0.714, p<0.001). By multivariate logistic regression analysis, FMD, SBP, hs-CRP and FRS were significantly associated with ED. In receiver-operating characteristic (ROC) analysis, FMD had high ability to predict ED in young man with low FRS (area under the curve (AUC) 0.921, p<0.001). The cut-off value of FMD <10.25% had sensitivity of 82.8% and specificity of 100% for diagnosis of ED. FRS and hs-CRP were also predictor of ED (AUC 0.812, p<0.001; AUC 0.645, p=0.011, respectively). Conclusions Subclinical endothelial dysfunction and low-grade inflammation may be the underlying pathogenesis of non-organic ED with no well-known aetiology. Young patients complaining ED should be screened for cardiovascular risk factors and possible subclinical atherosclerosis. Measurement of FMD, hs-CRP and FRS can improve our ability of early diagnosis and early treatment ED as well as subclinical cardiovascular disease in young males under the age of 40 years.