Xuejuan Jin

Adiponectin through its biphasic serum level is a useful biomarker during transition from diastolic dysfunction to systolic dysfunction - an experimental study

BackgroundAdiponectin is reported to relate with cardiovascular diseases, we sought to examine whether adiponectin is associated with disease progression of heart failure from hypertension in rats in comparison with other known biomarkers and echocardiographic parameters. Spontaneously hypertensive rats (SHR, n = 35), aged 1 month, were used and followed up to 18 months. High frequency echocardiography was performed both at baseline and every 3 months thereafter. Moreover, serum levels of N-terminal pro-natriuretic peptide (NT-proBNP) and interleukin-6 (IL-6) as well as serum level and tissue expression of adiponectin were determined at the same time as echocardiography.ResultsThe results clearly demonstrated time-dependent progression of hypertension and heart dysfunction as evidenced by gradually increased left ventricular mass index, NT-proBNP, IL-6 as well as gradually decreased cardiac function as assessed by echocardiography. Meanwhile, tissue and serum adiponectin decreased from 3 months and reached plateau until 12 months in parallel with decreasing of cardiac diastolic function. Thereafter, adiponectin levels increased prior to occurrence of systolic dysfunction. Adiponectin concentration is inversely related with NT-proBNP, IL-6 and E/E′ (correlation coefficient (r) = −0.756 for NT-proBNP, p < 0.001, -0.635 for IL-6, p = 0.002, and −0.626 for E/E′, p = 0.002, respectively) while positively correlated with E/A and E′/A′ (r = 0.683 for E/A, p = 0.001, 0.671 for E′/A′, p = 0.001, respectively). No difference for adiponectin distribution among visceral adipose tissues was found.ConclusionAdiponectin through its biphasic serum level is a useful biomarker during transition from diastolic dysfunction to systolic dysfunction.

Association of Renal Biochemical Parameters with Left Ventricular Diastolic Dysfunction in a Community-Based Elderly Population in China: A Cross-Sectional Study

Background Relationship of left ventricular diastolic dysfunction (LVDD) with parameters that could provide more information than hemodynamic renal indexes has not been clarified. We aimed to explore the association of comprehensive renal parameters with LVDD in a community-based elderly population. Methods 1,166 community residents (aged ≥ 65 years, 694 females) participating in the Shanghai Heart Health Study with complete data of renal parameters were investigated. Echocardiography was used to evaluate diastolic function with conventional and tissue Doppler imaging techniques. Serum urea, creatinine, urea-to-creatinine ratio, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were analyzed on their associations with LVDD. Results The prevalence of LVDD increased in proportion to increasing serum urea, urea-to-creatinine ratio and UACR. These three renal parameters were found negatively correlated to peak early (E) to late (A) diastolic velocities ratio (E/A), and positively to left atrial volume index; UACR also positively correlated with E to peak early (E’) diastolic mitral annular velocity ratio (E/E’). Serum urea, urea-to-creatinine ratio and UACR correlated with LVDD in logistic univariate regression analysis, and urea-to-creatinine ratio remained independently correlated to LVDD [Odds ratio (OR) 2.82, 95% confidence interval (CI) 1.34–5.95] after adjustment. Serum urea (OR 1.18, 95%CI 1.03–1.34), creatinine (OR 6.53, 95%CI 1.70–25.02), eGFR (OR 0.22, 95%CI 0.07–0.65) and UACR (OR 2.15, 95%CI 1.42–3.24) were revealed independent correlates of advanced (moderate and severe) LVDD. Conclusions Biochemical parameters of renal function were closely linked with LVDD. This finding described new cardio-renal relationship in the elderly population.

Venous thromboembolism risk assessment and thromboprophylaxis among hospitalized acute medical patients in China - the RAMP study

BACKGROUND In developed countries, hospitalized patients with acute medical conditions are at significant risk for venous thromboembolism (VTE). Little is known about VTE risk and prophylaxis practices in China. OBJECTIVE To determine the VTE risk and the frequency of recommended VTE prophylaxis in hospitalized Chinese patients with acute medical conditions. METHODS Multi-center, cross-sectional, observational study. ELIGIBILITY CRITERIA ≥30 years, admitted to an intensive care unit (ICU)/coronary care unit (CCU) for acute medical illness, had ≥1 VTE risk factor/1 disease that predisposes to VTE, and provided informed consent. We used 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines to assess VTE risk and the frequency of recommended VTE prophylaxis. RESULTS 1247 patients from 19 hospitals in 11 cities across 11 provinces of China were enrolled from July 2007 to June 2008. 57.3% patients had >2 VTE risk factors. Only 20.2% received ACCP-recommended VTE prophylaxis (CCU patients: 22.7%, ICU patients: 16.9%, p=0.0117). LIMITATIONS Excluding some patients with VTE risk factors did not allow assessment of the prevalence of VTE risk in the acute hospital-care setting. We could not determine whether the duration of prophylaxis complied with the ACCP recommendations. Our results may not be representative of hospitals in small cities/rural areas in China. CONCLUSIONS The prevalence of VTE risk factors in Chinese patients was similar to that in developed countries; however, only a small proportion of eligible patients received the recommended VTE prophylaxis. Our findings highlight the need for dissemination and implementation of appropriate VTE prophylaxis guidelines in China.

Observational study of Chinese medicine syndrome distribution in patients with acute myocardial infarction and its impact on prognosis

ObjectiveTo investigate the distribution of Chinese medicine (CM) syndrome in patients with acute myocardial infarction (AMI) on admission and its impact on prognosis.MethodsA total of 525 AMI patients were prospectively recruited and classifified into 4 groups based on their clinical characteristics: excess-heat, excess-cold, deficiency-heat and deficiency-cold syndromes. Major adverse cardiovascular events (MACEs) were followed up.ResultsThe excess syndrome was more common than deficiency syndrome (72.95% vs. 27.05%; P<0.05). Totally 495 (94.29%) of 525 AMI patients were followed up (median 277 days). There were 59 (11.92%) MACEs. After adjusted with confounding factors in Cox regression models, the hazard ratio (95% confifidence interval) of excess-heat, excess-cold, defificiency-heat and defificiency-cold syndrome groups were 1, 1.25 (0.63, 2.49; P<0.05), 2.37 (1.14, 4.94; P<0.05), 3.76 (1.71, 8.28; P<0.05), respectively.ConclusionsExcess syndrome was more common in AMI patients and had better prognosis, while defificiency-cold syndrome had the poorest prognosis. CM syndrome was of value in predicting long-term outcomes in AMI patients.

Prevalence and correlates of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in elderly community residents

BACKGROUND Left ventricular diastolic dysfunction (LVDD) is closely related to heart failure with preserved ejection fraction (HFpEF), while the prevalence and correlates of either LVDD or HFpEF in elderly population remain largely unknown. METHODS The study was performed in 1274 community residents (769 women, aged ≥65years) who participated in the Shanghai Heart Health Study. Demographic, laboratory and echocardiographic data were obtained to analyze correlates of LVDD and HFpEF using univariate and multivariate Logistic analysis. RESULTS LVDD was detected in 31.9% (406/1274) residents and it was significantly higher in women than in men (34.2% vs. 28.3%, P=0.027). HFpEF prevalence was 2.8% (35/1274), and increased with aging in the whole cohort. For residents with left ventricular ejection fraction ≥50% and normal-sized ventricular cavity, female sex (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.24-2.29), heart rate (OR 0.76, 95% CI 0.68-0.86), atrial fibrillation (OR 7.37, 95% CI 3.13-17.36), hypertension (OR 1.32, 95% CI 1.00-1.75), N-terminal pro-B type natriuretic peptide (OR 2.33, 95% CI 1.50-3.61) and high-sensitivity troponin T (hs-TnT) (OR 1.90, 95% CI 1.12-3.23) were independent correlates of asymptomatic LVDD. While age (OR 1.44, 95% CI 1.01-2.06), heart rate (OR 0.66, 95% CI 0.47-0.93) and hs-TnT (OR 4.37, 95% CI 1.46-13.12) were independently related to HFpEF. CONCLUSIONS LVDD is common in this community elderly population, and HFpEF is also not rare. Different factors played roles in different stages of HFpEF. Future studies are warranted to explore the predictors of LVDD and HFpEF in the community elderly.

Adiponectin through its biphasic serum level is a useful biomarker during transition from diastolic dysfunction to systolic dysfunction

Aims To examine whether adiponectin is associated with disease progression of heart failure from hypertension in rats in comparison with other known biomarkers and echocardiographic parameters. Methods Spontaneously hypertensive rats (SHR, n=35), aged 1 month, were used and followed up to 18 months. High frequency echocardiography was performed both at baseline and every 3 months thereafter. Moreover, serum levels of N-terminal pro-natriuretic peptide (NT-proBNP) and interleukin 6 (IL-6) as well as serum level and tissue expression of adiponectin were measured in the same time as echocardiography. Results Our results clearly demonstrated time-dependent progression of hypertension and heart dysfunction as evidenced by gradually increased left ventricular mass index, NT-proBNP, IL-6 and gradually decreased cardiac function as assessed by echocardiography. Meanwhile, tissue and serum adiponectin decreased from 3 months and reached plateau until 12 month in parallel with decreasing of cardiac diastolic function and then kept increasing prior to occurrence of systolic dysfunction. And adiponectin concentration is inversely related with NT-proBNP, IL-6 and E/E′ (correlation coefficient (r)=−0.756 for NT-proBNP, p<0.001, −0.635 for IL-6, p=0.002 and −0.626 for E/E′, p=0.002, respectively) while positively correlated with E/A and E′/A′ (r=was 0.683 for E/A, p=0.001, 0.671 for E′/A′, p=0.001, respectively). No difference for adiponectin distribution among visceral adipose tissues was found. Conclusions Adiponectin through its biphasic serum level is a useful biomarker during transition from diastolic dysfunction to systolic dysfunction.