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Wang M, Su W, Jiang CY, Li WP, Chen H, Li HW. Association Between Pulse Pressure With All-Cause and Cardiac Mortality in Acute Coronary Syndrome: An Observational Cohort Study. Front Cardiovasc Med 2022; 9:930755. [PMID: 35911514 PMCID: PMC9325995 DOI: 10.3389/fcvm.2022.930755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundPulse pressure (PP) is a surrogate of aortic stiffness, and reflects cardiac performance and stroke volume. Previous studies have indicated that PP was a robust predictor of cardiovascular outcomes and mortality. However, results have been mixed, and very few studies have focused on the association of PP with mortality in acute coronary syndrome (ACS). Thus, we aimed to investigate the relationship between admission PP and the prognosis of patients with ACS.MethodsThis cohort study included 10,824 patients diagnosed with ACS from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to October 2018. Patients with cardiogenic shock, malignancy, severe trauma and, no PP at admission were excluded. Restricted cubic spline and Cox proportional hazards regression were used to evaluate the association between PP and 1-year all-cause and cardiac mortality.ResultsIn the whole cohort, a total of 237 (2.19%) all-cause deaths were reported at 1-year follow-up. Restricted cubic spline analysis suggested a J-shaped relationship between PP and mortality. Among patients with ACS, both lower and higher PP levels were related to an increased risk of mortality (Pnon–linear < 0.001); with a PP level of 30 or 80 mmHg, as compared with 50 mmHg, the adjusted hazard ratios for 1-year all-cause mortality were 2.02 (95% CI, 1.27–3.22) and 1.62 (95% CI, 1.13–2.33), respectively, after adjustments for potential confounders. Similar results were observed for cardiac deaths. The J-shaped relationship between PP and mortality remained in a series of subgroup analyses.ConclusionOur results suggested that both low and high PP were associated with an increased risk of mortality in patients with ACS.
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Affiliation(s)
- Man Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen Su
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chun-Yan Jiang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei-Ping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
- *Correspondence: Hong-Wei Li,
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Wang Z, Li X, Wang Y, Bao B, Ding X, Li H, Li W. Association Between Admission Pulse Pressure and Long-Term Mortality in Elderly Patients With Type 2 Diabetes Mellitus Admitted for Acute Coronary Syndrome: An Observational Cohort Study. Front Cardiovasc Med 2022; 9:855602. [PMID: 35647076 PMCID: PMC9130650 DOI: 10.3389/fcvm.2022.855602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The aim of this study was to assess the effect of pulse pressure (PP) at admission on long-term cardiac and all-cause mortality among elderly patients with type 2 diabetes mellitus (T2DM) admitted for acute coronary syndrome (ACS). Methods This is a retrospective observational study. The patients aged at least 65 years with T2DM and ACS from January 2013 to April 2018 were enrolled and divided into 4 groups according to admission PP: <50 mmHg; 50–59 mmHg; 60–69 mmHg, and ≥70 mmHg. Multivariate Cox proportional hazard regression analyses and restricted cubic spline were performed to determine the association between PP and outcomes (cardiac and all-cause death). Results A total of 2,587 consecutive patients were included in this cohort study. The mean follow-up time was 39.2 months. The incidences of cardiac death and all-cause death were 6.8% (n = 176) and 10.8% (n = 280), respectively. After multivariate adjustment in the whole cohort, cardiac and all-cause mortality were significantly higher in PP <50 mmHg group and PP ≥70 mmHg group, compared with PP 50–59 mmHg group. Further analysis in acute myocardial infarction (AMI) subgroup confirmed that PP <50 mmHg was associated with cardiac death [hazard ratios (HR) 2.92, 95% confidence interval (CI) 1.45–5.76, P = 0.002] and all-cause death (HR 2.08, 95% CI 1.20–3.58, P = 0.009). Meanwhile, PP ≥70 mmHg was associated with all-cause death (HR 1.78, 95% CI 1.05–3.00, P = 0.031). However, admission PP did not appear to be a significant independent predictor in unstable angina pectoris (UAP) subgroup. There is a U-shaped correlation between PP and cardiac and all-cause mortality in the whole cohort and UAP subgroup and a J-shaped correlation in the AMI subgroup, both with a nadir at 50–59 mmHg. Conclusion In elderly patients with T2DM admitted for ACS, admission PP is an independent and strong predictor for long-term cardiac and all-cause mortality, especially in patients with AMI.
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Affiliation(s)
- Zijian Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China
| | - Xiaoran Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yichun Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Boyi Bao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
- Department of Internal Medicine, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Weiping Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
- *Correspondence: Weiping Li
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Zheng S, Zhao F, Yang R, Wu W, Liu H, Ma W, Xu F, Han D, Lyu J. Using Restricted Cubic Splines to Study the Trajectory of Systolic Blood Pressure in the Prognosis of Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:740580. [PMID: 34568468 PMCID: PMC8460999 DOI: 10.3389/fcvm.2021.740580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Acute myocardial infarction (AMI) is still the most serious manifestation of coronary artery disease. Systolic blood pressure (SBP) is the best predictor of blood pressure in AMI. Thus, its influence on AMI is necessary to be explored. Methods: A total of 4,277 patients with AMI were extracted from the Medical Information Mart for Intensive Care database. Chi-square test or Student's t-test was used to judge differences between groups, and Cox regression was used to identify factors that affect AMI prognosis. SBP was classified as low (<90 mmHg), normal (90-140 mmHg), or high (>140 mmHg), and a non-linear test was performed. Meaningful variables were incorporated into models for sensitivity analysis. Patient age was classified as low and high for subgroup analysis, and the cutoff value of the trajectory was identified. P < 0.05 indicates statistical significance. Results: The effect of SBP on the prognosis of patients with AMI is non-linear. The risks in models 1-3 with low SBP are 6.717, 4.910, and 3.080 times those of the models with normal SBP, respectively. The risks in models 1-3 with high SBP are 1.483, 1.637, and 2.937 times those of the models with normal SBP, respectively. The cutoff point (95% confidence interval) of the trajectory is 114.489 mmHg (111.275-117.702 mmHg, all P < 0.001). Conclusions: SBP has a non-linear effect on AMI prognosis. Low and high SBP show risks, and the risk of low SBP is obviously greater than that of high SBP.
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Affiliation(s)
- Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Fengzhi Zhao
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rui Yang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wentao Wu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Wen Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Fengshuo Xu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Didi Han
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
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U-shaped association of central pulse pressure with long-term prognosis after ST-segment elevation myocardial infarction. Heart Vessels 2019; 34:1104-1112. [PMID: 30671640 DOI: 10.1007/s00380-019-01344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
The relationship between central pulse pressure (CPP) measured at the time of primary percutaneous coronary intervention (PPCI) and long-term prognosis after ST-segment elevation myocardial infarction (STEMI) has not been investigated. CPP measurements were performed in 1348 patients with STEMI (327 women; mean age 62.5 ± 12.1 years) undergoing PPCI. Aortic systolic and diastolic blood pressure was measured before intervention. The primary outcome was 8-year all-cause mortality. The median [25-75th percentile] CPP value was 55.0 [43.0-70.0] mmHg. CPP correlated negatively with heart rate (P < 0.001), body mass index (P = 0.007), Killip class (P < 0.001) and initial area at risk (P < 0.001) and positively with age (P < 0.001), female sex (P < 0.001), diabetes (P = 0.012), arterial hypertension (P < 0.001) and glomerular filtration rate (P = 0.004). There were 181 deaths over the follow-up. In patients with CPP within the 1st, 2nd and 3rd tertiles, the Kaplan-Meier estimates of mortality were 17.3%, 10.8% and 24.2%, respectively; univariable hazard ratio [HR] =1.52, 95% confidence interval [CI] 0.99 to 2.32; P = 0.055 for tertile 1 vs. tertile 2 and HR =2.09 [1.36-3.21]; P < 0.001 for tertile 3 vs. tertile 2. For CPP values lower than 35 mmHg and higher than 71 mmHg, the association between CPP and all-cause mortality was significant (HR =1.276 [1.004-1.621] for the 35 mmHg value and HR =1.289 [1.003-1.657] for the 71 mmHg value) compared with the CPP reference value (54 mmHg). After adjustment, the association between CPP and all-cause mortality was attenuated (P = 0.304). In patients with STEMI undergoing PPCI there is a U-shaped association between CPP and mortality up to 8 years after PPCI.
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Xu T, Zhan Y, Lu N, He Z, Su X, Tan X. Double product reflects the association of heart rate with MACEs in acute coronary syndrome patients treated with percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:284. [PMID: 29197333 PMCID: PMC5712156 DOI: 10.1186/s12872-017-0714-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is little information about the prognostic value of double product (DP) for acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI). The aim of this study was to investigate whether DP reflects the predictive power of heart rate (HR) or systolic blood pressure (SBP) in ACS patients treated with PCI. METHODS A total of 7590 ACS patients who had undergone PCI, free from cardiac shock, were included. The follow-up duration was two years. The main adverse cardiovascular events (MACEs) included all-cause death, recurrent myocardial infarction and stroke. RESULTS In the unadjusted model, significantly higher rates of MACEs were recorded in the high DP group (relative risk 1.41, 95%CI 1.08 to 1.83, p = 0.012). However, in the full adjusted models, after including HR and SBP, the predictive value of DP was not significant (relative risk 0.86, 95%CI 0.55 to1.33, p = 0.499). The predictive value of HR for MACEs was statistically significant (relative risk 1.74, 95% CI 1.33-2.28, p < 0.001). It was worth noting that the history of hypertension was strongly associated with MACEs (relative risk 1.53, 95% CI 1.11-2.11, p = 0.009). CONCLUSION High DP is associated with MACEs for ACS patients treated with PCI. However, the predictive value of DP weakened when adjusted for HR. Therefore, we have shown that DP may reflect the predictive power of HR for ACS patients treated with PCI.
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Affiliation(s)
- Tan Xu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Changping Road NO.57, Shantou, Guangdong 515041 China
| | - Youqin Zhan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Changping Road NO.57, Shantou, Guangdong 515041 China
| | - Nan Lu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Changping Road NO.57, Shantou, Guangdong 515041 China
| | - Zhuoqiao He
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Changping Road NO.57, Shantou, Guangdong 515041 China
| | - Xi Su
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, Hubei 430022 China
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Changping Road NO.57, Shantou, Guangdong 515041 China
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Yin J, Liu H, Huan L, Song S, Han L, Ren F, Zhang Z, Zang Z, Zhang J, Wang S. Role of miR-128 in hypertension-induced myocardial injury. Exp Ther Med 2017; 14:2751-2756. [PMID: 28928797 PMCID: PMC5590046 DOI: 10.3892/etm.2017.4886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/13/2017] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to investigate the role and mechanism of micro RNA (miR)-128 in hypertension-induced myocardial injury. The peripheral blood of patients with hypertension was collected and the expression of miR-128 was detected using fluorescence reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Primary myocardial cells isolated from rat in vitro were cultured under conditions of hypoxia and glucose deprivation, and miR-128 expression was measured by RT-qPCR. The expression of c-Met protein was measured using western blot analysis and the apoptosis of transfected cells was measured by flow cytometry in rat myocardial cells following transfection with miR-128 mimics or c-Met siRNA. A luciferase assay was applied to assess the binding of miR-128 to c-Met mRNA. miR-128 expression was significantly higher in hypertension patients compared with controls (P<0.05). miR-128 expression was higher in patients with stage III/IV hypertension compared with patients with stage II hypertension. Similarly, miR-128 expression in primary cardiomyocytes cultured under deprivation of oxygen and glucose increased with the culture time and reached a peak at 12 h. c-Met expression decreased significantly (P<0.05) and the ratio of apoptotic cells increased significantly (P<0.05), following transfection of miR-128 mimics. The number of apoptotic cells also increased when c-Met expression was knocked down by siRNA. The dual luciferase assay indicated that fluorescence intensity decreased significantly in miR-128 mimics and wild type c-Met group (P<0.05), indicating that miR-128 can directly target c-Met. Therefore, the results of the current study suggest that miR-128 may promote myocardial cell injury by regulating c-Met expression.
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Affiliation(s)
- Jie Yin
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Hongyan Liu
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Lei Huan
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Suping Song
- Department of The Second Medicine, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Liying Han
- Ordance Industrial 521 Hospital, Xi'an, Shanxi 710000, P.R. China
| | - Faxin Ren
- Department of Cardiology, Yuhangding Hospital of Yantai, Yantai, Shangdong 264000, P.R. China
| | - Zengtang Zhang
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Zhiqiang Zang
- Department of Cardiology, Laiwu People's Hospital, Laiwu, Shangdong 271100, P.R. China
| | - Junye Zhang
- Laboratory of Cardiac Function, Qilu Hospital of Shangdong University, Jinan, Shandong 250012, P.R. China
| | - Shu Wang
- Sino German Laboratory, Fuwai Hospital, Beijing 100037, P.R. China
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