National assessment of early β-blocker therapy in patients with acute myocardial infarction in China, 2001-2011: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study

Circulating long non-coding RNA TTTY15 and HULC serve as potential novel biomarkers for predicting acute myocardial infarction

INTRODUCTION

Acute myocardial infarction (AMI) is a ubiquitous cardiovascular disease ensuing adverse prognosis caused by myocardial necrosis. Effective and rapid diagnosis of AMI is essential to following treatment in clinical practice while the existed biomarkers have inherent limitations. Consequently, exploration of novel biomarkers is needed. Long noncoding RNA (lncRNA) emerges as the upcoming biomarkers adopted in clinical use, and we aim at investigating the diagnostic power of lncRNA TTTY15 and HULC in AMI patients.

METHOD

We measured lncRNA level in 80 AMI patients and 36 healthy volunteers in discovering cohort and 50 AMI patients and 20 healthy volunteers in verification cohort with quantitative RT-PCR method. Receiver operating characteristic (ROC) analysis was administered to detect the diagnostic power of selected lncRNAs. Regression and correlation analyses were performed to explore the related factors.

RESULTS

ROC analysis reveals the superiority of TTTY15 and HULC as biomarkers against conventional AMI biomarkers CKMB (AUC of TTTY15: 0.915 versus CKMB: 0.768 versus TnT: 0.869); AUC of HULC: 0.905 versus CKMB: 0.768 versus TnT: 0.869). Regression and correlation analysis indicates that TTTY15 and HULC may be one of the contributing factors to AMI and related to accepted risk factors.

CONCLUSION

Our results revealed the diagnostic potency of lncRNA TTTY15 and HULC, and they could also be treated as novel therapeutic targets in AMI therapy, hinting inspiration to the cardiologist in clinical practice.

MALAT1 gene rs600231 polymorphism positively associated with acute coronary syndrome in Chinese population: a case-control study

Background

Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been recognized as a major player in the pathogenesis of coronary artery disease (CAD). The aim of the study was to determine the association between polymorphisms of the MALAT1 gene and acute coronary syndrome (ACS) in a Chinese population in Xinjiang.

Methods

In the case-control study, we genotyped three nucleotide polymorphisms (rs3200401, rs4102217, rs600231) of the MALAT1 gene using SNPscan^TM typing assays (1,053 controls and 929 ACS patients). Furthermore, we explored a predictive model using MALAT1 rs600231 and clinical variables to predict the risk of ACS. Finally, the relative expression of long noncoding RNA (lncRNA) MALAT1 was also measured in 92 ACS patients and 92 controls using quantitative real-time polymerase chain reaction (qRT-PCR).

Results

The prevalence of the GG genotype of rs600231 in ACS group was higher than that in control group (15.7% vs. 14.7%, P=0.048). The dominant model differed (AG + GG vs. AA) and the G allele of rs600231 in ACS group was higher than that in control group (for dominant model: 66.2% vs. 60.9%, P=0.014; for allele: 41.0% vs. 37.8%, P=0.042). Multivariate logistic regression analysis and the predictive nomogram model showed that the dominant model of rs600231 remained an independent risk factor for ACS [odds ratio (OR) =1.32, 95% confidence interval (CI): 1.07-1.63, P=0.009]. The area under the receiver operating characteristic (ROC) curve (AUC) for the nomogram model for the prediction of ACS was 0.738 (95% CI: 0.716-0.761). In addition, in the AG and GG phenotypes, the relative expression of lncRNA MALAT1 was significantly higher in ACS patients than in controls with the same phenotypes (P<0.05). Among ACS group, compared to other genotype carriers, the relative expression level of MALAT1 in GG genotype carriers was higher (P<0.05).

Conclusions

The present study suggested that the AG and GG genotype of rs600231 in MALAT1 gene was independently associated with ACS, and could be a risk genetic marker of ACS in a Chinese population in Xinjiang.

Impact of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome: protocol for a multicentre prospective study

INTRODUCTION

Metoprolol is the most frequently used β-receptor blockers; however, the prescribed dose in China is far less than the recommended doses in the guidelines. Based on the Chinese and International guidelines and the Chinese clinical practice, we are conducting this study (NCT03413410) to test the feasibility and tolerability of the metoprolol optimal dosing pathway by observing the percentage of patients achieving target dose in Chinese acute coronary syndrome (ACS) patients during hospitalisation.

METHODS AND ANALYSIS

A total of about 1000 patients aged ≥18 years, hospitalised for ACS will be enrolled from ~15 hospital sites in China between February 2018 and April 2019. The percentage of patients achieving the target metoprolol dosage at discharge is the primary endpoint. The secondary endpoints included the following: mean heart rate (HR) and blood pressure (BP) of the patients who have achieved target dose at discharge and during the follow-up period, percentage of patients experiencing bradycardia (HR <50 beats/min), hypotension (BP <90/60 mm Hg) and drug-related temporary heart failure worsening during hospitalisation and 1 month after discharge, respectively. We will also assess the proportion of patients reporting metoprolol-related adverse events and the leading causes for metoprolol discontinuation.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Ethics committee of the Chinese PLA General Hospital (number: S2017-112-01). Study findings will be disseminated through presentations at national and international conferences and submitted for publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov registry (NCT03413410).

Long non-coding RNAs H19, MALAT1 and MIAT as potential novel biomarkers for diagnosis of acute myocardial infarction

In this study, we evaluated the potential of peripheral blood mononuclear cells (PBMC) derived long non-coding RNAs (lncRNAs) as biomarkers for acute myocardial infarction (AMI). To assess the value of PBMCs-derived lncRNAs levels in predicting clinical outcomes in AMI. We measured the PBMC-derived levels of 10 individual lncRNAs which are known to be relevant to cardiovascular disease in PBMCs from 132 AMI patients and 104 healthy participants using quantitative RT-PCR. For AMI group, blood sample were obtained from patients after the onset of AMI. Out of the 10 lncRNAs tested, the mRNA level of lncRNA H19, MIAT and MALAT1 were significantly higher in AMI patients than in healthy control (2.3 ± 0.2 vs. 1.0 ± 0.1, p < 0.001, 1.5±0.1 vs. 1.0±0.1, p = 0.002, 1.8±0.2 vs. 1.0±0.1, p < 0.001, respectively). Receiver operating characteristic curve analyses showed that PBMC-derived H19 had significant diagnostic value for AMI (AUC, 0.753; 95% CI, 0.689˜0.817). Multivariate logistic regression analysis showed that H19 as a dangerous risk for AMI (OR = 2.498, 95% CI, 1.321-4.726, p = 0.005). In addition, the lncRNA H19 alteration was inversely associated with a number of cardiovascular protective factors, and positively associated with cardiovascular risk factors, such as high-density lipoprotein (HDL) (r=-0.198, p = 0.010), lipoprotein A (r=-0.153, p = 0.049), white blood cell counting (r=0.301, p < 0.001) and cardiac ejection fraction (r=-0.157, p = 0.042). Moreover, lncRNA H19 was positively correlated with cardiac biomarkers, i.e. troponinT (r=0.344,p < 0.001), CK (r=0.261, p = 0.001) and CKMB (r=0.24, p = 0.002). Hence, elevated expression level of PBMC-derived H19, MIAT and MALAT1 may be considered as novel biomarkers of AMI.

Quality of care in large Chinese hospitals: an observational study

OBJECTIVE

To empirically assess the quality of hospital care in China and trends over a 5-year period during which the government significantly increased its investment in healthcare.

DESIGN

Retrospective, observational study comparing hospital quality between two periods: October 2012-March 2013 and October 2017-March 2018.

SETTING

1-2 of the most reputable large tertiary hospitals in each of the 25 provinces in Mainland China (total of 33).

PARTICIPANTS

Adults 18 years or older admitted with acute myocardial infarction (AMI) (n = 7031), cerebral ischaemic stroke (n = 12 008), chronic obstructive pulmonary disease (COPD) (n = 11 836) and bacterial pneumonia (n = 4263).

MAIN OUTCOME MEASURES

Process-based quality measures, including seven AMI measures, three stroke measures, four COPD measures and six pneumonia measures.

RESULTS

In 2012/2013, Chinese hospitals had variable performance on AMI measures, including prescribing aspirin on arrival (80.7%), and discharging patients on aspirin (79.2%), β-blockers (60.8%) or statins (75.8%). This was similar for stroke cases and pneumonia cases. Smoking cessation advice was given at high rates across conditions though rates of influenza/pneumococcal vaccines were performed <1%. In 2017/2018, Chinese hospitals experienced no differences across most quality measures. Performance declined for two measures: aspirin on arrival for AMI cases and blood cultures before antibiotics for pneumonia cases. Performance increased for two measures: percutaneous coronary intervention within 90 min in ST segment elevation myocardial infarction cases (66.6% vs 80.1%, p<0.001) and statins at discharge for stroke cases (64.7% vs 78.7%, p<0.001). Compared with US hospitals, Chinese hospitals underperformed across most measures.

CONCLUSIONS

Chinese hospitals had low and variable performances across most quality measures for common medical conditions. Quality of care generally does not appear to be improving post national health reform. The Chinese government should include quality of care improvement in its health reform priorities to ensure patients receive appropriate and effective care.

Occurrence and enantiomer profiles of β-blockers in wastewater and a receiving water body and adjacent soil in Tianjin, China

A total of 58 samples were collected from hospitals, municipal wastewater treatment plants (WWTPs), a receiving water body (Dagu Drainage Canal, DDC), and adjacent farmland in Tianjin City, China, in May and November 2013 and were analyzed for five common β-blockers (atenolol, sotalol, metoprolol, propranolol, and nadolol) to elucidate their source, occurrence and fate in a typical city in China. The profiles of the enantiomers of the β-blockers in some samples were examined. Sotalol, metoprolol and propranolol were frequently detected, atenolol was less frequently detected, and nadolol was mostly not detected. Generally, the concentrations in hospital wastewaters occurred from <LOQ to 10 μg/L, while concentrations in municipal WWTP water samples ranged from <LOQ to 5.2 μg/L. Hence, both hospitals and WWTPs acted as sources of β-blockers in the environment. Sotalol, metoprolol and propranolol were determined in soils adjacent to the DDC with concentrations up to hundreds of ng/kg in the topsoil and declining levels in the subsoil. Seasonal variation was observed with samples obtained in May showing higher concentrations, both in the canal and the adjacent soil, which could be ascribed to greater consumption of these drugs, lower temperature and less precipitation in the spring and the former winter. Enantiomeric fractions (EFs) of metoprolol and propranolol in soil samples showed a trend of enrichment of E1 (first-eluted) compared to E2 (second-eluted), while sotalol was almost racemic. In the DDC, no significant difference was found for the pair enantiomers of each β-blocker, while in hospital and WWTP wastewaters, E1 predominated.

Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing

Background

Quality of care (QoC) attracts global concerns when unsafe and misuse of healthcare wastes resources and endangers people’s health, especially in low- and middle-income countries. However, little is known about quality of care delivered in China. This study was intended to gauge the quality of care for acute myocardial infarction (AMI) patients in Beijing and identify the quality gaps across tertiary hospitals.

Methods

One thousand two hundred twenty eight patients, covered by Employee Essential Health Insurance Scheme and diagnosed of AMI, was sampled from 14 large comprehensive hospitals in Beijing, China. Chart review study was conducted through the discharge data and medical records of inpatients to evaluate 6 quality outcomes of interest, including the use of aspirin, beta blocker, and statin at discharge; use of aspirin within 24 h at arrival; angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD); percutaneous transluminal coronary intervention (PCI) within 90 min at arrival.

Results

Of the 1228 subjects, the mean age was 60.8 (11.8 SD) years and 83.0% were male. The overall medication prescribed was highly compliant with the clinical guidelines (97.0% [95% CI 96.8–97.2] for aspirin and 96.3% [95% CI 96.0–96.5] for statin), except for beta-blocker (83.6% [95% CI 83.0–84.1]) and ACEI/ARB use (61.4% [95% CI 60.7–62.2]). More than half of eligible patients did not receive appropriate PCI therapy (44.0% [95% CI 42.5–45.4]). Great variations across hospitals was observed in aspirin within 24 h and beta-blocker at discharge (P < 0.001), and the risk-adjusted results remained robust.

Conclusion

Underuse of recommended treatment and significant variations of quality were found for AMI patients across tertiary hospitals in Beijing. It raised great concerns on poorer quality of care in other less-developed areas with less medical resources. Practical actions are needed in reducing quality gaps to ensure the delivery of quality care.

Acute Effects of Particulate Air Pollution on the Incidence of Coronary Heart Disease in Shanghai, China

INTRODUCTION

Evidence based on ecological studies in China suggests that short-term exposure to particulate matter (PM) is associated with cardiovascular mortality. However, there is less evidence of PM-related morbidity for coronary heart disease (CHD) in China. This study aims to investigate the relationship between acute PM exposure and CHD incidence in people aged above 40 in Shanghai.

METHODS

Daily CHD events during 2005-2012 were identified from outpatient and emergency department visits. Daily average concentrations for particulate matter with aerodynamic diameter less than 10 microns (PM10) were collected over the 8-year period. Particulate matter with aerodynamic diameter less than 2.5 microns (PM2.5) were measured from 2009 to 2012. Analyses were performed using quasi-poisson regression models adjusting for confounders, including long-term trend, seasonality, day of the week, public holiday and meteorological factors. The effects were also examined by gender and age group (41-65 years, and >65 years).

RESULTS

There were 619928 CHD outpatient and emergency department visits. The average concentrations of PM10 and PM2.5 were 81.7 μg/m3 and 38.6 μg/m3, respectively. Elevated exposure to PM10 and PM2.5 was related with increased risk of CHD outpatients and emergency department visits in a short time course. A 10 μg/m3 increase in the 2-day PM10 and PM2.5 was associated with increase of 0.23% (95% CI: 0.12%, 0.34%) and 0.74% (95% CI: 0.44%, 1.04%) in CHD morbidity, respectively. The associations appeared to be more evident in the male and the elderly.

CONCLUSION

Short-term exposure to high levels of PM10 and PM2.5 was associated with increased risk of CHD outpatient and emergency department visits. Season, gender and age were effect modifiers of their association.