Zhenda Zheng

Association of serum gamma-glutamyltransferase with arterial stiffness in established coronary artery disease.

Serum gamma-glutamyltransferase (GGT) has been reported to predict vascular risk. We enrolled 978 patients (507 men and 471 women) with established coronary artery disease (CAD). The GGT, brachial–ankle pulse wave velocity ([baPWV] to assess arterial stiffness), and conventional risk factors were evaluated. The means of baPWV tend to increase in both genders according to GGT tertiles. Body mass index, GGT, logarithmical (systolic blood pressure [LnSBP]), uric acid (UA), total bilirubin, Ln (cholinesterase), and Ln (total cholesterol) were correlated with baPWV in men in a multivariate model. However, only GGT, LnSBP, UA, and Ln (high-density lipoprotein cholesterol) were correlated with baPWV in women. The GGT was a significant determinant for increased baPWV both in men (β = 0.017; P < .001) and in women (β = 0.015; P < .001). In conclusion, GGT was independently associated with increased arterial stiffness both in men and in women with established CAD.

Trimetazidine improves exercise tolerance in patients with ischemic heart disease : A meta-analysis.

AimThis study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).MethodsStudies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO2), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).ResultsIn all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95 % CI: 25.58–49.13, p < 0.00001), pVO2 (WMD: 2.41, 95 % CI: 1.76–3.06, p < 0.00001), METS (WMD: 1.33, 95 % CI: 0.38–2.28, p = 0.006), and 6-WMT (WMD: 62.46, 95 % CI: 35.86–89.05, p < 0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95 % CI: 22.28–47.25, p < 0.001), but not in diabetic participants (WMD: 40.36, 95 % CI: − 18.76–99.48, p = 0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95 %CI: 18.35–52.60, p < 0.0001 and WMD: 49.94, 95 %CI: 44.69–55.19, p < 0.00001). In addition, TMZ improved TED (WMD: 50.01, 95 % CI: 44.77–55.25 and WMD: 24.20, 95 % CI: 12.72–35.68) in IHD patients with or without heart failure (HF), respectively.ConclusionAddition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.ZusammenfassungZielZiel der vorliegenden Studie war es, die Wirkung von Trimetazidin (TMZ) zusätzlich zu der Standardtherapie auf die Belastungstoleranz bei Patienten mit ischämischer Herzerkrankung („ischemic heart disease“, IHD) zu untersuchen.MethodenStudien wurden über eine systematische Suche in den Datenbanken PubMed, Embase, Cochrane Library und in der chinesischen CNKI (China National Knowledge Infrastructure) von Januar 1978 bis Januar 2015 gesucht. Die Datenerfassung, -synthese und statistische Analyse erfolgten mit Standardmethoden der Metaanalyse. Random- oder Fixed-Effects-Modelle wurden eingesetzt, um die gepoolten mittleren Differenzen bei der Gesamtbelastungsdauer („total exercise duration“, TED), der Spitzensauerstoffaufnahme („peak oxygen uptake“, pVO2), dem metabolischen Äquivalentsystem („metabolic equivalent system“, METS) und dem 6-min-Gehtest („6-minute walking test“, 6-MWT) abzuschätzen.ErgebnisseEs wurden 16 randomisierte kontrollierte Studien (RCT) mit 2004 Teilnehmern in die Auswertung eingeschlossen. Die gepoolten Ergebnisse zeigten, dass die TMU-Behandlung zu einer signifikanten Verbesserung der TED (gewichtete mittlere Differenz, WMD: 37,35; 95 %-Konfidenzintervall, 95%-KI: 25,58–49,13; p < 0,00001), der pVO2 (WMD: 2,41; 95 %-KI: 1,76–3,06; p < 0,00001), des METS (WMD: 1,33; 95 %-KI: 0,38–2,28; p = 0,006) und des 6-WMT (WMD: 62,46; 95 %-KI: 35,86–89,05; p < 0,001) bei allen Patienten mit IHD führte.Die Subgruppenanalyse ergab, dass TMZ die TED bei Teilnehmern ohne Diabetes mellitus signifikant erhöhte (WMD 34,77; 95 %-KI: 22,28–47,25; p < 0,001), nicht aber bei Teilnehmern mit Diabetes (WMD: 40,36; 95 %-KI: − 18,76–99,48; p = 0,18). Und aus der Subgruppenanalyse der TED nach Interventionsdauer ergaben sich Hinweise darauf, dass statistisch kein Unterschied zwischen der 3-monatigen und der 6-monatigen Dauer bestehe (WMD: 35,47; 95 %-KI: 18,35–52,60; p < 0,0001 bzw. WMD: 49,94; 95 %-KI: 44,69–55,19; p < 0,00001). Außerdem zeigte sich eine Verbesserung der TED unter TMZ (WMD: 50,01; 95 %-KI: 44,77–55,25 bzw. WMD: 24,20; 95 %-KI: 12,72–35,68) bei IHD-Patienten mit bzw. ohne Herzinsuffizienz.SchlussfolgerungDie zusätzliche Gabe von TMZ zur Standardbehandlung verbesserte die Belastungstoleranz signifikant bei Patienten mit ischämischer Herzerkrankung. IHD-Patienten mit Herzinsuffizienz haben möglicherweise noch einen größeren Nutzen. Es gibt jedoch keine ausreichende Evidenz dafür, dass TMZ einen Nutzeffekt bei Teilnehmern mit Diabetes mellitus habe.

Preprocedure and Postprocedure Predictive Values of Serum β2-Microglobulin for Contrast-Induced Nephropathy in Patients Undergoing Coronary Computed Tomography Angiography: A Comparison With Creatinine-Based Parameters and Cystatin C.

Objective This study aimed to investigate the values of serum &bgr;2-microglobulin to predict contrast-induced nephropathy (CIN) before and early after coronary computed tomography angiography (CCTA), comparing with creatinine-based parameters and cystatin C. Methods A total of 424 patients were enrolled. Serum &bgr;2-microglobulin, cystatin C, and creatinine were measured at 0, 24, and 48 hours of CCTA. Contrast-induced nephropathy was defined as an elevation of serum creatinine level by 25% or higher or 0.5 mg/dL or greater from baseline within 48 hours. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease study equation. Receiver operating characteristic curves and multivariate logistic regression analysis were used to detect the efficiency of biomarkers in predicting CIN. Results Fifty-two subjects (12.26%) developed CIN. Before CCTA, CIN was predicted by both baseline &bgr;2-microglobulin (area under the receiver operating characteristic curve [AUC], 0.791; P < 0.001) and cystatin C (AUC, 0.781; P < 0.001), whereas creatinine and eGFR were not predictive. After CCTA, CIN was predicted by both the absolute post-CCTA levels of &bgr;2-microglobulin, cystatin C, creatinine, and eGFR (AUC, 0.842 vs 0.961 vs 0.691 vs 0.688 at 24 hours, P < 0.001; and 0.937 vs 1.000 vs 0.908 vs 0.898 at 48 hours, P < 0.001) and their relative changes (&Dgr;) to baseline (AUC, 0.677 vs 0.846 vs 0.850 vs 0.844 at 24 hours, P < 0.001; and 0.731 vs 0.968 vs 0.984 vs 0.966 at 48 hours, P < 0.001). Multivariate regression analysis confirmed that baseline &bgr;2-microglobulin (odds ratio, 2.137; 95% confidence interval, 1.805–3.109; P < 0.001) and cystatin C (odds ratio, 1.873; 95% confidence interval, 1.667–2.341; P = 0.003) were independent predictors for CIN. Conclusions Serum &bgr;2-microglobulin, with values superior to creatinine-based parameters and similar with cystatin C, was a useful biomarker for the prediction of CIN at pre-CCTA and early post-CCTA.

Trimetazidine improves exercise tolerance in patients with ischemic heart disease

AimThis study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).MethodsStudies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO2), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).ResultsIn all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95 % CI: 25.58–49.13, p < 0.00001), pVO2 (WMD: 2.41, 95 % CI: 1.76–3.06, p < 0.00001), METS (WMD: 1.33, 95 % CI: 0.38–2.28, p = 0.006), and 6-WMT (WMD: 62.46, 95 % CI: 35.86–89.05, p < 0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95 % CI: 22.28–47.25, p < 0.001), but not in diabetic participants (WMD: 40.36, 95 % CI: − 18.76–99.48, p = 0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95 %CI: 18.35–52.60, p < 0.0001 and WMD: 49.94, 95 %CI: 44.69–55.19, p < 0.00001). In addition, TMZ improved TED (WMD: 50.01, 95 % CI: 44.77–55.25 and WMD: 24.20, 95 % CI: 12.72–35.68) in IHD patients with or without heart failure (HF), respectively.ConclusionAddition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.ZusammenfassungZielZiel der vorliegenden Studie war es, die Wirkung von Trimetazidin (TMZ) zusätzlich zu der Standardtherapie auf die Belastungstoleranz bei Patienten mit ischämischer Herzerkrankung („ischemic heart disease“, IHD) zu untersuchen.MethodenStudien wurden über eine systematische Suche in den Datenbanken PubMed, Embase, Cochrane Library und in der chinesischen CNKI (China National Knowledge Infrastructure) von Januar 1978 bis Januar 2015 gesucht. Die Datenerfassung, -synthese und statistische Analyse erfolgten mit Standardmethoden der Metaanalyse. Random- oder Fixed-Effects-Modelle wurden eingesetzt, um die gepoolten mittleren Differenzen bei der Gesamtbelastungsdauer („total exercise duration“, TED), der Spitzensauerstoffaufnahme („peak oxygen uptake“, pVO2), dem metabolischen Äquivalentsystem („metabolic equivalent system“, METS) und dem 6-min-Gehtest („6-minute walking test“, 6-MWT) abzuschätzen.ErgebnisseEs wurden 16 randomisierte kontrollierte Studien (RCT) mit 2004 Teilnehmern in die Auswertung eingeschlossen. Die gepoolten Ergebnisse zeigten, dass die TMU-Behandlung zu einer signifikanten Verbesserung der TED (gewichtete mittlere Differenz, WMD: 37,35; 95 %-Konfidenzintervall, 95%-KI: 25,58–49,13; p < 0,00001), der pVO2 (WMD: 2,41; 95 %-KI: 1,76–3,06; p < 0,00001), des METS (WMD: 1,33; 95 %-KI: 0,38–2,28; p = 0,006) und des 6-WMT (WMD: 62,46; 95 %-KI: 35,86–89,05; p < 0,001) bei allen Patienten mit IHD führte.Die Subgruppenanalyse ergab, dass TMZ die TED bei Teilnehmern ohne Diabetes mellitus signifikant erhöhte (WMD 34,77; 95 %-KI: 22,28–47,25; p < 0,001), nicht aber bei Teilnehmern mit Diabetes (WMD: 40,36; 95 %-KI: − 18,76–99,48; p = 0,18). Und aus der Subgruppenanalyse der TED nach Interventionsdauer ergaben sich Hinweise darauf, dass statistisch kein Unterschied zwischen der 3-monatigen und der 6-monatigen Dauer bestehe (WMD: 35,47; 95 %-KI: 18,35–52,60; p < 0,0001 bzw. WMD: 49,94; 95 %-KI: 44,69–55,19; p < 0,00001). Außerdem zeigte sich eine Verbesserung der TED unter TMZ (WMD: 50,01; 95 %-KI: 44,77–55,25 bzw. WMD: 24,20; 95 %-KI: 12,72–35,68) bei IHD-Patienten mit bzw. ohne Herzinsuffizienz.SchlussfolgerungDie zusätzliche Gabe von TMZ zur Standardbehandlung verbesserte die Belastungstoleranz signifikant bei Patienten mit ischämischer Herzerkrankung. IHD-Patienten mit Herzinsuffizienz haben möglicherweise noch einen größeren Nutzen. Es gibt jedoch keine ausreichende Evidenz dafür, dass TMZ einen Nutzeffekt bei Teilnehmern mit Diabetes mellitus habe.

The prognostic value of exercise-induced ventricular arrhythmias in patients with and without coronary artery disease: A meta-analysis

BACKGROUND Significance of exercise-induced ventricular arrhythmias (EIVAs) is controversial. This meta-analysis aimed to determine the prognostic value of EIVAs in patients with and without coronary artery disease (CAD). METHODS Relevant studies were searched on Pubmed though December, 2015. Pooled odds ratio (OR) of endpoints (all-cause death, cardiac death or cardiac events) for all included studies was calculated at first to explore the significance of EVIAs in unselected population. Then, sensitivity analysis based on CAD status of population was performed to determine ORs of endpoints in CAD population, non-CAD population and mixed population, respectively. RESULTS A total of 14 studies examining 23,002 patients were included, with 5 studies involved CAD population, 4 involved non-CAD population, and 5 involved mixed population (%CAD ranged from 51.2% to 76.8%). EIVAs in unselected population were associated with a pooled OR of 1.626 (95%CI 1.334 to 1.983, p<0.001) of endpoints when compared with those without EIVAs. Sensitivity analysis further indicated that pooled ORs of endpoints were 1.395 (95%CI 1.061 to 1.833, p=0.017) in CAD population, 1.933 (95%CI 1.567 to 2.384, p<0.001) in non-CAD population, and 1.402 (95%CI 1.198 to 1.640, p<0.001) in mixed population. Heterogeneous among studies was identified. Meta-regression analysis found that study quality, mean follow-up period, percentage of lost, percentage of diabetes were associated with ORs of endpoints. CONCLUSIONS EIVAs were associated with increased risk of worse outcomes, no matter the patients had CAD or not. However, more studies are required to confirm this finding due to the variation of current evidences.

Trimetazidine improves exercise tolerance in patients with ischemic heart disease@@@Verbesserung der Belastungstoleranz durch Trimetazidin bei Patienten mit ischämischer Herzerkrankung: A meta-analysis@@@Eine Metaanalyse

AimThis study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).MethodsStudies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO2), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).ResultsIn all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95 % CI: 25.58–49.13, p < 0.00001), pVO2 (WMD: 2.41, 95 % CI: 1.76–3.06, p < 0.00001), METS (WMD: 1.33, 95 % CI: 0.38–2.28, p = 0.006), and 6-WMT (WMD: 62.46, 95 % CI: 35.86–89.05, p < 0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95 % CI: 22.28–47.25, p < 0.001), but not in diabetic participants (WMD: 40.36, 95 % CI: − 18.76–99.48, p = 0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95 %CI: 18.35–52.60, p < 0.0001 and WMD: 49.94, 95 %CI: 44.69–55.19, p < 0.00001). In addition, TMZ improved TED (WMD: 50.01, 95 % CI: 44.77–55.25 and WMD: 24.20, 95 % CI: 12.72–35.68) in IHD patients with or without heart failure (HF), respectively.ConclusionAddition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.ZusammenfassungZielZiel der vorliegenden Studie war es, die Wirkung von Trimetazidin (TMZ) zusätzlich zu der Standardtherapie auf die Belastungstoleranz bei Patienten mit ischämischer Herzerkrankung („ischemic heart disease“, IHD) zu untersuchen.MethodenStudien wurden über eine systematische Suche in den Datenbanken PubMed, Embase, Cochrane Library und in der chinesischen CNKI (China National Knowledge Infrastructure) von Januar 1978 bis Januar 2015 gesucht. Die Datenerfassung, -synthese und statistische Analyse erfolgten mit Standardmethoden der Metaanalyse. Random- oder Fixed-Effects-Modelle wurden eingesetzt, um die gepoolten mittleren Differenzen bei der Gesamtbelastungsdauer („total exercise duration“, TED), der Spitzensauerstoffaufnahme („peak oxygen uptake“, pVO2), dem metabolischen Äquivalentsystem („metabolic equivalent system“, METS) und dem 6-min-Gehtest („6-minute walking test“, 6-MWT) abzuschätzen.ErgebnisseEs wurden 16 randomisierte kontrollierte Studien (RCT) mit 2004 Teilnehmern in die Auswertung eingeschlossen. Die gepoolten Ergebnisse zeigten, dass die TMU-Behandlung zu einer signifikanten Verbesserung der TED (gewichtete mittlere Differenz, WMD: 37,35; 95 %-Konfidenzintervall, 95%-KI: 25,58–49,13; p < 0,00001), der pVO2 (WMD: 2,41; 95 %-KI: 1,76–3,06; p < 0,00001), des METS (WMD: 1,33; 95 %-KI: 0,38–2,28; p = 0,006) und des 6-WMT (WMD: 62,46; 95 %-KI: 35,86–89,05; p < 0,001) bei allen Patienten mit IHD führte.Die Subgruppenanalyse ergab, dass TMZ die TED bei Teilnehmern ohne Diabetes mellitus signifikant erhöhte (WMD 34,77; 95 %-KI: 22,28–47,25; p < 0,001), nicht aber bei Teilnehmern mit Diabetes (WMD: 40,36; 95 %-KI: − 18,76–99,48; p = 0,18). Und aus der Subgruppenanalyse der TED nach Interventionsdauer ergaben sich Hinweise darauf, dass statistisch kein Unterschied zwischen der 3-monatigen und der 6-monatigen Dauer bestehe (WMD: 35,47; 95 %-KI: 18,35–52,60; p < 0,0001 bzw. WMD: 49,94; 95 %-KI: 44,69–55,19; p < 0,00001). Außerdem zeigte sich eine Verbesserung der TED unter TMZ (WMD: 50,01; 95 %-KI: 44,77–55,25 bzw. WMD: 24,20; 95 %-KI: 12,72–35,68) bei IHD-Patienten mit bzw. ohne Herzinsuffizienz.SchlussfolgerungDie zusätzliche Gabe von TMZ zur Standardbehandlung verbesserte die Belastungstoleranz signifikant bei Patienten mit ischämischer Herzerkrankung. IHD-Patienten mit Herzinsuffizienz haben möglicherweise noch einen größeren Nutzen. Es gibt jedoch keine ausreichende Evidenz dafür, dass TMZ einen Nutzeffekt bei Teilnehmern mit Diabetes mellitus habe.

Response to serum γ-glutamyltransferase (GGT) should be evaluated together with other inflammatory markers in clinical practice.

We reported that serum g-glutamyltransferase (GGT) activity is independently associated with increased arterial stiffness both in men and in women with established coronary artery disease (CAD). Cakar et al noted that raised serum GGT activity in a patient may be due to a problem with biliary epithelium, cholestasis, or excessive alcohol usage. The GGT itself without other inflammatory markers may not provide information to the clinicians about the endothelial inflammation. They noted that further studies are needed to define the role of GGT as an inflammatory marker and its association with arterial stiffness in both healthy and patients with atherosclerosis. Also, they noted alcohol consumption is a leading cause of serum GGT activity elevation and that it might be useful if we provided information about alcohol consumption. Serum GGT activity has long been regarded as a marker for hepatobiliary disease and alcohol consumption, but several studies have indicated that slightly elevated serum GGT that is almost within the reference range is significantly associated with all-cause mortality as well as increased risk of myocardial infarction and stroke. In the CARDIA study, serum GGT values were strongly and positively correlated with determinants of oxidative stress such as the levels of C-reactive protein (CRP), uric acid, and fibrinogen. Saijo et al found that GGT is independently associated with an increased level of CRP in both males and females. In addition, in males GGT is related to an increased level of arterial stiffness. High serum GGT activity was directly associated with the increased risk of arterial stiffness, in general, and with peripheral polyneuropathy in patients with diabetes in an ethnic She Chinese population. In our study, we found that serum GGT activity is associated with arterial stiffness determined by brachialankle pulse wave velocity in patients with established CAD without a known history of diseases of the hepatobiliary system. In a large healthy population, Jung et al found that GGT is independently associated with the increased level of arterial stiffness both in men and in women, and the association between them appears to be stronger in men compared to women. In our study, we could not obtain details about alcohol consumption. This is a limitation of our study. Followup studies are needed to observe the effect of alcohol consumption on arterial stiffness in patients with established CAD.