Huan Zheng

EFFECTS OF 6 MONTHS EXERCISE TRAINING ON VENTRICULAR REMODELLING AND AUTONOMIC TONE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND PERCUTANEOUS CORONARY INTERVENTION

OBJECTIVE To study the effects of 6 months exercise training on ventricular remodelling and autonomic tone in patients with acute myocardial infarction and percutaneous coronary intervention. DESIGN Single-blinded randomized control trial. PARTICIPANTS Sixty patients with acute myocardial infarction who had undergone percutaneous coronary intervention. METHODS The exercise group followed a 6-month supervised exercise programme, while the control group received routine recommendations. All patients underwent an incremental cardiopulmonary exercise test and Doppler echocardiography at baseline and after 6 months. RESULTS Three patients in the exercise group did not complete the programme. At 6 months follow-up, an improvement was seen in the exercise group compared with the control group regarding peak VO2 (p<0.01), Powermax (p<0.05), VO2 at anaerobic threshold (p<0.01), time to reach anaerobic threshold (p<0.05), heart rate recovery (p<0.01), left ventricular end-diastolic diameter (p<0.01) and left ventricular ejection fraction (p<0.05). CONCLUSION Six months exercise training in patients with acute myocardial infarction and percutaneous coronary intervention with mild ventricular systolic dysfunction could prevent ventricular remodelling to a certain extent, and favourable modulating sympatho-vagal balance may be an important mechanism.

Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction

BackgroundLeft ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction. As bilirubin is regarded as an important endogenous antioxidant molecule, serum total bilirubin levels were compared between heart failure patients with a preserved left ventricular ejection fraction and normal controls in this study. We recruited 327 heart failure patients with a preserved left ventricular ejection fraction and 200 healthy controls. Patients were divided into 4 subgroups by their comprehensive echocardiographic manifestations, 1-mild, 2-moderate, 3-severe (reversible restrictive), 4-severe (fixed restrictive). Total bilirubin levels were compared using stepwise multiple regressions adjusted for selected factors.ResultsAfter adjusting for gender, age, smoking, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride, serum total bilirubin levels were significantly lower in the heart failure group compared with the control group (P < 0.01). Patients in the subgroup (4-severe) showed significantly (P < 0.05) lower levels of total bilirubin when compared with the subgroup (1-mild).ConclusionsTB level was negatively correlated with left ventricular diastolic dysfunction in heart failure patients with a preserved left ventricular ejection fraction, which might provide a new insight into the complicated mechanisms of heart failure with a preserved left ventricular ejection fraction.

Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia

Abstract The study was designed to assess left ventricular (LV) systolic and diastolic function in hypertensive patients with or without Hhcy. The study participants consisted of 40 hypertensive patients with Hhcy, 40 hypertensive patients without Hhcy and 40 age-matched healthy control participants. Cardiac functions were determined using echocardiography and the Tei index was calculated for analysis. LAVI (left atrial volume index), IVST (interventricular septum thickness in diastole), PVST (posterior ventricular septum thickness in diastole), LVMI (left ventricular mass index), E/A (peak early and late diastolic transmitral filling flow velocities ratio), DT (deceleration time of the E wave), IRT (isovolumic relaxation time), and the Tei index were different in the hypertensive patient groups (hypertension with Hhcy and hypertension without Hhcy) compared with the controls. The Tei index was significantly higher in the hypertensive groups compared with the controls (0.62 ± 0.05, 0.51 ± 0.04, and 0.40 ± 0.04, respectively, p < 0.01). Significant differences were also observed between the hypertensive patients with Hhcy and the hypertensive patients without Hhcy regarding LAVI (25.6 ± 4.7 versus 22.9 ± 3.5 ml/m2), E/A (0.73 ± 0.22 versus 0.92 ± 0.14), DT (93.1 ± 6.9 versus 84.3 ± 8.1 ms), IRT (93.1 ± 6.9 versus 84.3 ± 8.1 ms) and the Tei index. Significant correlations were observed between serum homocysteine levels and LV diastolic function parameters (LAVI: r = 0.39, E/A: r = −0.32, DT: r = 0.47, IRT: r = 0.51, p < 0.05). We found that Hhcy had contributory effects on myocardial impairment induced by hypertension. Moreover, there were strong relationships between homocysteine level and LV diastolic dysfunction parameters.

Polymorphism of the methylenetetrahydrofolate reductase gene C677T and its influence on the antihypertensive and vascular protective effects of short-term lercanidipine treatment

OBJECTIVE To determine whether the antihypertensive and vascular protective effects of short-term treatment with lercanidipine, a calcium channel blocker, are modulated by the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism. METHODS In a self-controlled study, a total of 143 essential hypertensive patients, all permanent residents of Shanghai, were included. All of them were treated orally with lercanidipine at a single daily fixed dosage of 10mg for 28 consecutive days and the genotypes of the MTHFR C677T polymorphism were determined. Blood pressures, ankle-brachial index values (ABI), and pulse wave velocity (PWV) were measured at baseline and on the 29th day. RESULTS The 110 subjects for whom complete genotype and phenotype information were available were used for final data analysis. Patients with the TT genotype showed higher baseline diastolic blood pressure (DBP) than those with the CC and CT genotypes (P=0.018). Within each genotype group, SBP, DBP and PWV showed significant difference between baseline and after treatment (P<0.05). However, ABI showed significant difference between baseline and after treatment only within the CT and TT groups (P<0.05) but not in the CC group (P>0.05). Patients with the TT genotype presented a greater reduction in normalized PWV than those with the CC and CT genotypes (P=0.02). Patients in all genotype groups had statistically similar changes in normalized SBP, DBP and ABI (P>0.05). CONCLUSION The MTHFR gene polymorphism C677T might be associated with the vascular protective effects of short-term lercanidipine treatment. However, the MTHFR C677T polymorphism might not affect the antihypertensive effects of the lercanidipine treatment.

Comparison of oxidative stress biomarkers in hypertensive patients with or without hyperhomocysteinemia

ABSTRACT Hyperhomocysteinemia is an independent risk factor for cardiovascular impairment in hypertension. Oxidative stress is important in the molecular mechanisms associated with hypertension, but there are few studies focusing on the comparison of oxidative stress biomarkers in hypertensive patients with or without hyperhomocysteinemia. The study included 50 newly diagnosed hypertensive patients with hyperhomocysteinemia, 50 newly diagnosed hypertensive patients without hyperhomocysteinemia, and 50 age-matched healthy controls. Serum levels of malondialdehyde, nitric oxide, 8-isoprostane-F2ɑ, superoxide dismutase, catalase, and glutathione peroxides were compared. Levels of malondialdehyde and 8-isoprostane-F2ɑ were higher in both hypertensive groups than in the control group (8.3 ± 1.8 μmol/L vs. 6.5 ± 1.3 μmol/L vs. 4.3 ± 1.2 μmol/L, P < 0.05; 23.5 ± 12.1 pg/mL vs. 17.4 ± 10.3 pg/mL vs. 13.9 ± 7.5 pg/mL, P < 0.05), while levels of superoxide dismutase and catalase were lower in both hypertensive groups than in the control group (120.5 ± 13.7 U/mL vs. 131.3 ± 18.2 U/mL vs. 149.1 ± 14.6 U/mL, P < 0.05; 23.8 ± 7.4 U/mL vs. 24.6 ± 9.2 U/mL vs. 33.5 ± 8.2 U/mL, P < 0.05). In hypertensive subgroups, serum malondialdehyde levels were higher in the hyperhomocysteinemia group than the other group (8.3 ± 1.8 μmol/L vs. 6.5 ± 1.3 μmol/L; P < 0.05), and superoxide dismutase activities were lower in the hyperhomocysteinemia group than the other group (120.5 ± 13.7 U/mL vs. 131.3 ± 18.2 U/mL; P < 0.05). Moreover, in hypertensive patients, homocysteine levels were significantly correlated with malondialdehyde (r = 0.39, P < 0.01), 8-isoprostane-F2ɑ (r = 0.47, P < 0.05), superoxide dismutase (r = −0.51, P < 0.01), and catalase (r = −0.51, P < 0.05), respectively. Our findings demonstrated oxidative stress was more severe in hypertensive patients with hyperhomocysteinemia than those hypertensive patients without it. Besides, there were strong relationships between homocysteine activities and oxidative/antioxidative parameters, which indicated that homocysteine might aggravate the oxidative stress in hypertension to produce contributory effects on cardiovascular impairment.

T-cell subsets are associated with serum homocysteine concentration in patients with essential hypertension

ABSTRACT Objective: To explore the association between serum homocysteine (Hcy) concentration and T-cell subsets from patients with essential hypertension. Patients and Methods: A total of 218 essential hypertension patients were recruited, of which 170 were H-type essential hypertensive and 48 were non-H-type essential hypertensive. H-type essential hypertensive patients were divided into three groups by concentration of serum Hcy. The peripheral blood T-cell subsets (CD3+%, CD4+%, CD8+ T%, CD4+/CD8+) and clinical features including age, sex, serum creatinine, uric acid, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were recorded and analyzed with T-cell subsets which were counted by fluorescence activated cytometry. Results: Compared with non-H-type hypertensive patients, CD4+ T-cell percentage in peripheral blood was significantly decreased in H-type hypertensive patients. Because of the increase of Hcy level, CD4+ T-cell percentage decreased. Linear regression analysis showed that Hcy level was negatively correlated with CD4+ T-cell percentage; however, it was positively correlated with CD3+ T-cell percentage. Conclusion: A direct association between serum Hcy concentrations and T-cell percentage was observed in patients with essential hypertension. This observation indicates that T-cell subsets might play an important role in hypertension.

Leptin is associated with heart rate recovery in Chinese hypertensive patients

ABSTRACT Elevated serum leptin concentrations are closely related to sympathetic nervous system activation in essential hypertension (EH); however, it is not clear whether or not they are associated with parasympathetic nervous system impairment in EH. Heart rate recovery (HRR) is a reproducible method used to assess parasympathetic activity. This study aimed to investigate the relationship between serum leptin and HRR in Chinese untreated EH patients. This was a cross-sectional study enrolling 471 Chinese EH patients (205 men, 266 women; mean age 63.1 years). HRR was calculated during an incremental cardiopulmonary exercise test. Simple and multiple regression analyses were used to assess the correlation between serum leptin level and HRR value. Serum leptin levels elevated with increasing BP values. Moreover, univariate analysis revealed that the HRR value was negatively correlated with serum leptin (r = −0.037, P < 0.01). In multiple regression analysis, the age-adjusted serum leptin level was negatively correlated with HRR (β = −0.268, P < 0.01). Serum leptin remained negatively associated with HRR (β = −0.017, P < 0.01) after further adjustments for factors including age, systolic blood pressure, total cholesterol, and several factors that correlated with HRR. Our findings demonstrated that a raised serum leptin concentration is related to HRR blunt, which suggests that the role of leptin in the development of EH might be associated with impairment of the parasympathetic nervous system as well.

Sphingomyelin levels in nondipper and dipper hypertensive patients

A number of studies have focused on the association between sphingomyelin (SM) levels and atherosclerosis, however, there are few data concerning the correlation of SM with nondipper hypertension. The present study aimed to investigate the correlation between plasma SM levels and nondipper status in patients with hypertension. A total of 200 hypertensive patients were enrolled and divided into two groups according to their ambulatory blood pressure monitoring (AMBP) results: Dipper group (84 patients) and nondipper group (116 patients). All patients were subjected to transthoracic echocardiography examination and laboratory tests. No statistically significant difference was observed between the two groups in terms of basic clinical characteristics. However, the plasma SM levels in the dipper group were significantly lower than those of the nondipper group (41.9±17.5 vs. 96.4±14.3 mg/dl, P=0.003). The left ventricular mass index (LVMI) was higher in the nondipper patients than in the dipper patients and the diastolic function parameters in the nondipper patients were less favorable. Correlation analysis showed that the SM level was negatively correlated with the magnitude of systolic blood pressure (SBP) fall at night (r=−0.42, P<0.01) and diastolic blood pressure (DBP) fall at night (r=−0.31, P<0.01). The nondipper status had contributory effects on hypertensive concentric hypertrophy and diastolic function impairment. In addition, the plasma SM level was associated with a nondipper pattern of hypertension.

Effects of Angiotensin-Converting Enzyme Inhibitory Peptide LAP on Vascular Remodeling

The aim of this article is to study the efficiency of an angiotensin-converting enzyme (ACE)-inhibitory peptide LAP on the blood pressure (BP) and the vascular remodeling in spontaneously hypertensive rats (SHRs). Ten-week-old male SHRs were divided into four groups with 10 animals in each group and treated for 2 months: blank, pseudo-experimental (NS), enalapril (ENA), and LAP. The alterations of BP, plasma angiotensin II (AngII) levels, and morphological changes of left common carotid artery and the third level of superior mesenteric artery were investigated. After 2 weeks of treatment, LAP and ENA significantly decreased BP and the antihypertensive effects lasted till the end of experiment. After 2 months, LAP and ENA also significantly lowered plasma AngII levels. LAP and enalapril significantly lowered vascular medial thickness, media thickness/lumen diameter, medial cross-sectional area, and mean nuclear area of smooth muscle cells in left common carotid artery. When compared to the blank group, LAP and ENA significantly lowered the percentages of collagen fibers in the vascular area of left common carotid artery with 24.84 ± 0.53, 23.36 ± 0.99 versus 31.82 ± 0.57 (blank), respectively, and those of the third level of superior mesenteric artery with 15.82 ± 0.60, 15.15 ± 0.71 versus 23.42 ± 0.72, respectively. LAP had a beneficial effect on BP and vascular remodeling in SHRs. These findings suggest the potential therapeutic value of LAP in the treatment of hypertension.