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Objective: To investigate whether plasma levels of low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) are associated with coronary flow reserve (CFR) in patients with type 2 diabetes mellitus (DM)., Methods: Between October 2007 and March 2012,we continuously enrolled 200 participants registered to Department of Cardiology, Peking University Third Hospital, who were divided into 2 groups: DM group (n = 95) and control group (n = 105). Quantification of CFR was administrated after rest and after adenosine by noninvasive Doppler echocardiography in all the subjects. The CFR, which was performed in the distal part of left descending artery, was used as an indicator of coronary endothelial dysfunction., Results: The plasma levels of LDL-C were significantly higher in the patients with DM than in the controls [(3.05 ± 0.73) mmo/L vs. (2.74 ± 0.72) mmo/L, P = 0.003)], while the plasma levels of HDL-C were significantly lower in the patients with DM than in the controls [(1.08 ± 0.24) mmo/L vs. (1.17 ± 0.29) mmo/L, P = 0.044]. Furthermore, a lower CFR value was seen in the patients with DM than in the controls [(2.74 ± 0.63) vs. (3.20 ± 0.69), P < 0.001]. The plasma levels of LDL-C were negatively correlated with the CFR values in all the subjects (r = -0.17, P = 0.015) and in the DM group (r = -0.23, P = 0.021). The LDL-C remained independently correlated with the CFR in the DM group (P = 0.036). However,no significantly correlation was found between HDL-C and CFR in the DM group or in all the subjects., Conclusion: LDL-C is independently associated with CFR in patients with diabetic mellitus.

Objective: To explore the current status of morning blood pressure and medication of hypertensive patients in Beijing., Methods: This study included 2187 hypertensive patients who visited the ambulance of our cardiology department in the morning (7:00-10:00) from March 2012 to April 2012. Patients were divided into three groups: no antihypertensive agent group, single antihypertensive drug therapy group (include CCB, ARB, ACEI, β-blocker) and combined drug therapy group at least one month. Blood pressure control rate was compared among the groups., Results: Target blood pressure was not reached in 1193 patients (54.6%), most patients took CCB and the target blood pressure was not reached in 61.7% (295/478) patients taking CCB. There was no significant difference on target blood pressure uncontrolled rate among the four single drug subgroups (CCB, ARB, ACEI, β-blocker). The blood pressure uncontrolled rate was 46.3% (63/136) for amlodipine, 70.5% (55/78) for nifedipine and 73.8% (31/42) for felodipine. There OR of uncontrolled blood pressure rate was 0.36 (amlodipine vs. nifedipine, 95%CI:0.20-0.65) and 0.31% (amlodipine vs. felodipine, 95%CI:0.14-0.66)., Conclusion: The morning blood pressure uncontrolled rate is high in hypertensive patients visiting Beijing tertiary hospitals. Amlodipine is possible superior to nifedipine and felodipine on morning blood pressure control in this patient cohort.

Objective: To assess the diagnostic accuracy of coronary flow reserve measured by transthoracic Doppler echocardiography (TTDE) associated with adenosine triphosphate (ATP) stress for detecting coronary stenosis in patients with chest pain., Methods: A total of 125 patients scheduled for elective coronary angiography (CAG) due to chest pain were recruited. ATP stress echocardiography were performed to measure CFR in left anterior descending (LAD) by TTDE with 2 days pre-CAG. Coronary flow reserve (CFR) was calculated as peak diastolic velocity during maximum hyperemia (PDV2) divided by baseline (PDV1). According to the coronary angiography results, all patients were divided into group A (stenosis < 50% in LAD, n = 57), group B (stenosis of 50% - 75% in LAD, n = 20) and group C (stenosis > 75% in LAD, n = 48). Then CFR was compared among three groups. The receiver operating characteristic curve (ROC) was used to assess the value of CFR for detecting LAD stenosis., Results: CFR was significantly different among three groups (group A: 3.02 ± 0.85, group B: 2.49 ± 0.65, group C: 1.82 ± 0.56; all P < 0.01). With ROC analysis, CFR < 2.2 was the best cut-off value for diagnosing significant LAD stenosis (area under curve: 0.86 (95% CI 0.80 to 0.93)), with sensitivity of 81%, specificity of 83% and accuracy of 82%; CFR < 2.2 for diagnosing LAD stenosis > 50% (area under curve: 0.81 (95%CI 0.74 - 0.89, P < 0.01)), with a sensitivity of 59%, a specificity of 82% and an accuracy of 70%., Conclusions: CFR measured by TTDE associated with ATP stress is a valuable tool for screening significant stenosis in patients with chest pain. Its advantages are non-invasiveness, easy availability, safety and inexpensiveness.

Objective: To investigate the correlation between left atrial size and left ventricular filling pressure (LVFP) and the value of left atrial size assessment on detecting diastolic dysfunction in hypertensive patients with preserved LVEF by echocardiography., Methods: Echocardiography was performed in 346 hypertensive patients with preserved LVEF(≥ 50%), left atrial size including left atrial diameter (LAD) and left atrial area (LAA) was measured and indexed to body surface area (LADI, LAAI). The ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) was determined and LVFP was calculated with the formula: LVFP = 1.24×E/Em + 1.9. Patients were divided into diastolic dysfunction group [DD group, LVFP > 15 mm Hg (1 mm Hg = 0.133 kPa), n = 81] and normal diastolic function group (NDF group, LVFP ≤ 15 mm Hg, n = 265)., Results: As compared to patients in NDF group, the patients in DD group had larger LA [LADI: (21.4 ± 2.6) mm/m(2) vs. (19.6 ± 2.4) mm/m(2); LAAI: (12.1 ± 2.6) cm(2)/m(2) vs. (10.4 ± 1.7)cm(2)/m(2); all P < 0.01]. LA size parameters were positively correlated with LVFP (r = 0.211-0.450, all P < 0.01), LAAI was best correlated with LVFP (r = 0.450, P < 0.01). ROC analysis showed that LAAI ≥ 11.4 cm(2)/m(2) diagnosed DD with a sensitivity of 63%, specificity of 74% and accuracy of 72%., Conclusion: Left atrium dilation correlates positively with LVFP in hypertensive patients with preserved LVEF. The LAAI is a more accurate parameter for identifying patients with diastolic dysfunction in this cohort.

Objective: To explore the early changes of arterial elasticity in initial hypertension through two different methods., Methods: A total of 76 hypertensive patients (Grade 1-2, n = 32) were assigned into hypertension group while the age and gender-matched healthy population was selected as normal group (n = 44). All of them were monitored for baPWV in right carotid artery by wave intensity technique. The parameters of two methods were compared between two groups., Results: Higher bi-lateral baPWV were found in the hypertension group (right: (1472 ± 198) m/s vs (1353 ± 233) m/s), (left: (1465 ± 198) m/s vs (1353 ± 241) m/s) (P < 0.05). Compared with the normal group, Patients in the hypertension group had statistically higher W(1) ((9.8 ± 3.8)×10(3) mm Hg×m×s(-3) vs (7.4 ± 2.4)×10(3)) mm Hg×m×s(-3), W(2) ((2.8 ± 1.1)×10(3) mm Hg×m×s(-3) vs (2.0 ± 1.0)×10(3) mm Hg×m×s(-3)), stiffness parameter (β) ((6.9 ± 2.6) vs (5.1 ± 1.3)), pressure-strain elastic modulus (Ep) ((99 ± 39) kPa vs (57 ± 17) kPa), one-point wave velocity (PWVβ) ((6.0 ± 1.1) m/s vs (4.6 ± 0.6) m/s), PWVWI ((6.2 ± 1.4) m/s vs (4.4 ± 1.0) m/s) (P < 0.01). R-W(1) ((100 ± 14) ms vs (103 ± 13) ms), (W(1)-W(2)) ((261 ± 20) ms vs (274 ± 15) ms) and arterial compliance (AC) ((0.8 ± 0.4) mm(2)/kPa vs (1.1 ± 0.3) mm(2)/kPa) in the hypertension group were statistically lower than those of the normal group (P < 0.05)., Conclusion: The initial hypertensive patients may have impaired arterial elasticity during an early stage.

Objective: To assess left ventricular vortex and flow vector features and the relationship between vector flow and left ventricular systolic function in patients with anterior myocardial infarction by echocardiography-derived vector flow mapping (VFM)., Methods: Echocardiography was performed in 31 patients with anterior myocardial infarction and 20 healthy controls. Flow vector and velocity of left ventricle were analyzed on apical 3 chambers view with color Doppler., Results: (1) Left ventricular intracavitary vortex during isovolumic contraction phase could be detected in both groups. Vortex was detectable also during contraction phase and relaxation phase in patients with myocardial infarction. There was no vortex during contraction phase, and there was only small and transit vortex during relaxation phase in control group. (2)Flow vector of apex and middle segments directed to apex and was opposite to that of basal segment of left ventricle in patients with myocardial infarction and in controls [(10.6 ± 8.3) cm/s vs. -(5.8 ± 7.2) cm/s, (19.5 ± 11.8) cm/s vs. -(16.6 ± 14.7) cm/s]. During rapid relaxation phase, the velocity in apex was lower in patients with myocardial infarction than that in control group [(6.8 ± 9.8) cm/s vs. (17.6 ± 15.8) cm/s, P < 0.01]. (3) There was a negative correlation between velocity in apex and left ventricular ejection fraction (LVEF) during rapid eject phase in patients with anterior myocardial infarction (r = -0.52, P < 0.05). Velocity in apex of patients with LVEF < 50% was higher than that of patients with LVEF ≥ 50% during rapid eject phase [(13.5 ± 9.0) cm/s vs. (5.8 ± 5.1) cm/s, P < 0.05]., Conclusions: Vortex period is prolonged in patients with anterior myocardial infarction compared to normal controls during whole cardiac cycle, flow vector of apex and middle segments is directed to apex during eject phase and there is a negative correlation between velocity in apex and LVEF during rapid eject phase in patients with anterior myocardial infarction.

Objective: To assess the prognostic values for in-hospital event rate of tissue Doppler imaging (TDI) parameter (E/Em) after acute myocardial infarction., Methods: A total of 289 patients with acute myocardial infarction were retrospectively examined. Their clinical data and echocardiograms were obtained. Clinical events were recorded. Patients were divided into two groups according to the value of ratio of early transmitral flow velocity to early diastolic velocity of mitral annulus (E/Em): Group E/Em < 10 (n = 152) and Group E/Em ≥ 10 (n = 137). Clinical characteristics, echocardiographic parameters and the rate of cardiac events were compared. Predictors of heart failure were identified by multivariate Logistic regression analysis., Results: On echocardiography, the patients with an E/Em ratio ≥ 10 had statistically larger left atrial diameter [(39.1 ± 6.2) vs (36.0 ± 4.4) mm, P = 0.000] and left ventricular end diastolic diameter [(52.3 ± 7.3)vs (49.2 ± 5.2) mm, P = 0.000]. Worse systolic functions were found in group E/Em ≥ 10: left ventricular ejection fraction (LVEF) [(48.3 ± 11.7)% vs (56.7 ± 9.7)%, P = 0.000]. Systolic velocities of mitral annulus (Sm) [(6.6 ± 1.7) vs (8.6 ± 2.2) cm/s, P = 0.000]. Em [(6.4 ± 1.9) vs (9.4 ± 2.4) cm/s, P = 0.000] was statistically lower than that of E/Em < 10 group. Killip classes on admission were statistically higher in group E/Em ≥ 10 than those of the other group [(1.7 ± 0.9) vs (1.2 ± 0.6), P = 0.000]. So were as the ratio of heart failure (38.5% vs 13.8%, P = 0.000) and in-hospital mortality rate (4.4% vs 0.8%, P = 0.000). Logistic regression analysis demonstrated that the independent risk factors of heart failure included the value of E/Em and LVEF., Conclusion: Early E/Em is probably a powerful predictor for left ventricular remodeling and in-hospital heart failure in patients after acute myocardial infarction.

Objective: To investigate the importance of abnormal glucose metabolism in a chronic heart failure (CHF) population., Methods: A total of 444 patients were enrolled sequentially for decompensated CHF from January 1st, 2005 to December 31st, 2007 at our department. They were divided into diabetic (n = 153, 34.5%) and non-diabetic groups (n = 291, 65.5%). Among the non-diabetics, there were 113 (25.4%) with impaired fasting glucose (IFG) (FPG 5.6-6.9 mmol/L) and 178 (40.1%) with normal glucose levels. All subjects received a follow-up to record their clinical status, biochemical parameters and end-point events (all-cause death in one year). And the correlations of abnormal glucose metabolism and end-point events were analyzed., Results: Among these patients, 83 (17.1%) died in 1 year, 31 (7.0%) were lost to follow-up; Among 83 dead patients, 15 (8.4%) were within normal glucose levels, 34 (21.2%) with IFG and 44 (28.8%) with diabetes mellitus. Compared with normal glucose level patients, the mortality rates of diabetes mellitus and IFG patients were higher (P < 0.01). There was no significant difference in mortality rate between diabetes mellitus and IFG patients. After adjustment for other prognostic attributes (age, sex and etc.), diabetes mellitus was a predictor of 1-year all-cause mortality (OR = 2.383, 95% CI: 1.317 to 4.312; P = 0.004). In diabetics, the mortality of the higher glucose level group (FPG > 7.0 mmol/L) was 30.4% and that of the lower glucose level group (FPG < or = 7.0 mmol/L) 27.4%. And there was no significant difference (P > 0.05). The FPG level could not predict the 1-year all-cause mortality. In non-diabetics, the mortality of IFG group (FPG 5.6 - 6.9 mmol/L) was significantly higher than that of normal glucose levels group (21.2% vs 8.4%, P < 0.01). IFG status predicted 1-year all-cause mortality (OR = 3.564, 95%CI: 1.494 - 8.497, P = 0.004). The FPG level was also associated with the 1-year all-cause mortality (OR = 1.791, 95%CI: 1.090 - 2.943, P = 0.021)., Conclusion: Diabetes mellitus is an independent predictor of 1-year all-cause mortality for CHF. And IFG and a higher FPG level are associated with 1-year all-cause mortality for CHF without diabetes mellitus.

A 13-year-old girl presented with a 1-month history of progressive exertional dyspnea (NYHA class IV) and exophthalmos for 6 months. She had a history of long-standing asthma and the presence of allergy. Hypereosinophilia and increased serum IgE levels (2472 IU/mL) were observed. Chest radiography and a high resolution CT scan documented a massive interstitial pulmonary infiltration. Echocardiography confirmed mild tricuspid regurgitation, apical obliteration of the right ventricle by fibrocalcific thickening of the endocardium and echogenic material suggestive of thrombosis. Churg-Strauss syndrome with cardiac involvement (endomyocardiopathy) was diagnosed. The patient received anticoagulation and corticosteroid therapy. In view of rapidly progressive severe endomyocardiopathy and stable hematology, the patient was referred for cardiac surgery. Histopathological examination of resected specimens confirmed laminated thrombus but without any trace of eosinophils embedded.

Objective: To investigate the effects of beta-adrenoceptor agonist isoproterenol(ISO) on lipopolysaccharide(LPS) induced inflammatory cytokine-tumor necrosis factor-alpha(TNF-alpha) and interleukin-6(IL-6)] in monocytes from essential hypertensive patients (Stage I)., Methods: Monocytes were isolated from 17 healthy volunteers and 6 hypertensive patients' venus blood, and the monocytes were cultured with LPS (0.2 microg/L) and ISO. The concentrations of TNF-alpha and IL-6 in the cultured supernatant were measured with enzyme-linked immunosorbent assays., Results: (1) TNF-alpha production induced by LPS in monocytes from hypertensive group were higher than those from control group [(1,897+/-393) ng/L vs. (975+/-473) ng/L, P<0.01]. But the differences of IL-6 production were not significant between the two groups [(5,532+/-796) ng/L vs. (6,092+/-2 249) ng/L, P>0.05]. (2) ISO inhibited extracellular TNF-alpha production induced by LPS in a dose-dependent manner. The inhibitory effects were ameliorated by beta-adrenoceptor antagonist propranolol. In contrast, ISO had no effect on the production of IL-6 induced by LPS. The difference of inhibitory effects of ISO on TNF-alpha production was not statistically significant between hypertensive group and healthy control group (P>0.05)., Conclusion: beta-adrenergic activation inhibits TNF-alpha (but not IL-6) production induced by LPS in monocytes. The inhibitory effects were not different between early staged hypertensive patients and healthy subjects.

Objective: To compare the different expressions of cardiac inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta(IL-1beta), interleukin-6 (IL-6) in two types of cardiac hypertrophy rat models induced by volume overload and pressure overload., Methods: Volume overload-induced cardiac hypertrophy was established by abdominal arteriovenous fistula (ACF) and pressure overload-induced cardiac hypertrophy was developed by constriction of aorta (CA). Heart weight measurement and histological examination were performed 1 week or 2 weeks after the operation respectively. The cytokine expression was measured by enzyme linked immunosorbent assay., Results: All the operated groups developed cardiac hypertrophy. The left ventricular fractional shortening of each operated group had no significant difference with the sham-operated groups respectively. As far as the total amount of each cytokine in left ventricular myocardium was concerned, compared to the sham-operated groups, IL-6 and IL-1beta both increased significantly in CA groups [IL-6(23 722+/-8 671)pg vs (17 693+/-5 705)pg,P<0.05 ;IL-1beta(335+/-95)pg vs (159+/-99) pg,P<0.01].There was no difference of TNF-alpha between operated and sham-operated groups in ACF or CA groups ., Conclusion: The contents of IL-6 and IL-1beta in myocardium increased in pressure overload-induced cardiac hypertrophy.

Objective: To analyze the clinical and echocardiographic features of constrictive pericarditis., Methods: Thirty-six patients diagnosed as having constrictive pericarditis from Oct. 1989 to Jun. 2007 were enrolled in this retrospective study. Clinical manifestations and echocardiographic features were analyzed., Results: The main clinical manifestations were fatigue, effort dyspnea(100%), and sign of pressure elevation of vena cava(97%). Echocardiographic features included thickening of pericardium(67%), abnormal motion of septal and posterior wall of left ventricle in diastole(83%, 75% respectively), left and right atrial enlargement(92%,39% respectively), early filling changes of mitral flow with respiration(93%), inferior vena cava dilation and without respiration variation(100%), mitral annulus paradoxical enhanced motion in early diastole., Conclusion: Clinical manifestations of pressure elevation of vena cava were indicators for diagnosis of constrictive pericarditis. Echocardiography could be a valuable method for confirming the diagnosis.

Objective: To investigate the influence of rehabilitation on left ventricular remodeling and systolic function in acute myocardial infarction patients., Methods: Patients meeting the inclusion criteria with uneventful clinical course after a first myocardial infarction were randomly assigned to a 3-month exercise training period (exercise group, n = 35) or a control group (n = 29). Before randomization, all patients underwent NT-proBNP test, 2-dimensional echocardiography, and submaximal exercise test., Results: (1) At baseline, there were no significant differences in NT-proBNP, left ventricular end-diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) between the exercise and control groups. After 3 months, a significant decrease in NT-proBNP was observed only in the exercise group [from (845.29 +/- 93.48) ng/L to (335.64 +/- 246.14) ng/L, P < 0.05], but not in the control group [from (1091.62 +/- 101.78) ng/L to (1099.83 +/- 168.75) ng/L, P > 0.05) and there was significant difference in NT-proBNP level between the two groups after 3 months (P < 0.01). The LVDd increased in the control group [from (50.9 +/- 5.8) to (52.6 +/- 5.4) mm, P < 0.05] but not in the exercise group [from (50.7 +/- 4.5) to (50.3 +/- 3.9) mm, P > 0.05] and there was significant difference in LVDd between the two groupsafter 3 months (P < 0.05). Conversely, LVEF improved in the exercise group [from (55.0 +/- 8.6)% to (60.0 +/- 8.0)%, P < 0.05] but not in the control group (P > 0.05) and there was significant difference in LVEF between the two groups after 3 months (P < 0.05). (2) NT-proBNP was inversely correlated with LVEF., Conclusions: Rehabilitation exercise training under instructions based on family condition in the early and recovery stage of AMI can lower the NT-proBNP level, improve ejection fraction, and prevent the increase of left ventricular end-diastolic diameter. Therefore, it may reduce unfavorable remodeling response and improve cardiac systolic function hereafter.

Objective: To study the mechanism of stem cell factor (SCF) in bone marrow stem cells heart transplantation (BMT) and the influence of bone marrow mobilization on the transplantation efficacy., Methods: Rats with acute myocardial infarction (AMI) accepted BMT. The SCF expression in the bone marrow was measured by RT-PCR after the operation. Then bone marrow stem cells with different SCF levels for the transplantation were used and the cardiac function was compared by using echocardiography. The SCF protein expression in the heart, plasma and bone marrow was detected by ELISA., Results: SCF expression level decreased significantly 1 week after AMI (P < 0.01), but it didn't decrease in those accepting BMT. Though the rats accepted BMT with bone marrow stem cells from different sources, the cardiac function showed no difference (P > 0.05). After BMT, the SCF protein level in the plasma decreased significantly (P < 0.05)., Conclusions: BMT may make mobilization through SCF. Bone marrow stem cells from rats with AMI and also those with myocardial infarction plus BMT therapy can also be used for the transplantation into heart, and have no influence on cardiac function improvement.

To get insights into the principles of gene expression changes during cardiac hypertrophy, three rat cardiac hypertrophy models were prepared, i.e., suprarenal abdominal aortic stenosis (SRS), arterial-vein fistula (AVF) and continuous jugular vein infusion of norepinephrine (NEi). The cardiac function and structure were analyzed by echocardiograph as well as histological examination. Total RNA of left ventricles was extracted and gene expression profiles were analyzed by cDNA microarray. SRS and NEi induced concentric cardiac hypertrophy and AVF induced eccentric hypertrophy in rats, among which NEi caused obvious cardiac fibrosis. The changes of gene expression profiles were compared comprehensively across different pathologic cardiac hypertrophy models. While gene expression profiles of different cardiac hypertrophy models compared with pairs, parts of the genes involved were found overlapped, and mostly the gene expression changed in the same direction between two models, but some of them changed in the opposite directions. Expression levels of 19 genes were found changed across all cardiac hypertrophy models, and genes relatively regulated in a specific model was also found when comparison of all the three models was carried out. Novel clues for further study might derive from the results mentioned above, and some genes might be the marker genes of cardiac hypertrophy or the targets of therapy.

The purpose of the present study was to observe the expression of Axin protein during cardiac remodeling in rats. Cardiac remodeling animal models were prepared with the methods of jugular venous norepinephrine (NE)-infusion or arterial-vein fistula (AVF). The ultrasonic parameters of rat hearts were recorded before sacrifice. The expressions of Axin protein were determined by Western blot in rat hearts from different remodeling models as well as cultured cardiac fibroblasts from adult rats. Cardiac concentric hypertrophy and fibrosis was induced by 3-day jugular vein infusion of NE in rats. The expression of Axin in the left ventricles increased significantly compared with that of the control group. Cardiac eccentric hypertrophy without fibrosis was induced by A-V fistula for one week in rats, and no change in Axin protein expression in the left ventricles was observed. In cultured adult rat cardiac fibroblasts, NE treatment for 24 h increased significantly the Axin protein level. It is therefore concluded that Axin protein was expressed in rat heart and increased significantly in left ventricles during NE-induced rat cardiac remodeling, which may be relevant to cardiac fibrosis.