Serum Aldosterone as Predictor of Progression of Coronary Heart Disease in Patients Without Signs of Heart Failure After Acute Myocardial Infarction

Diagnostic value of scoring model of treadmill exercise test combined with dynamic electrocardiogram for latent coronary heart disease

OBJECTIVE

To investigate the diagnostic value of scoring model of treadmill exercise test (TET) combined with dynamic electrocardiogram (DECG) for latent coronary heart disease (LCHD).

MATERIALS AND METHODS

Using coronary angiography, the diagnostic values of TET and DECG alone or combination for LCHD of 200 eligible patients were compared. The effects of different clinical features and DECG indices on the positive detection rate of TET combined with DECG were compared. Multivariate logistic regression analysis was performed for factors influencing diagnostic accuracy, and nomogram prediction model was established using screened independent risk factors.

RESULTS

Serial and parallel combinations of TET and DECG had superior sensitivity, specificity, positive and negative predictive values and accuracy than those of single detection. Patients with an age > 65 years, smoking, hypertension, diabetes mellitus, hyperlipidemia, family history of CHD and positive DECG indicators had higher positive detection rate, as independent risk factors for accuracy. The diagnostic accuracy of TET combined with DECG predicted by the nomogram model was 82.9%. The actual concordance index (C-index) for model evaluation was 0.817, the C-index after internal validation was 0.811, and the C-index after external validation was 0.802, indicating a good concordance of the model.

CONCLUSIONS

TET combined with DECG has high diagnostic accuracy for LCHD, and the scoring model constructed by DECG indicators can prominently improve the accuracy of combined diagnosis. Therefore, TET combined with DECG is significantly better than TET or DECG alone, which is of great diagnostic value for LCHD.

Nonsteroidal Mineralocorticoid Receptor Antagonists: Exploring Role in Cardiovascular Disease

ABSTRACT

Aldosterone, a mineralocorticoid hormone, plays a role in the pathophysiology of many cardiovascular disease states. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve clinical outcomes in select patient populations. However, use of available steroidal receptor antagonists, eplerenone and spironolactone, is often limited by the risk or development of hyperkalemia. Nonsteroidal MRAs have been designed to overcome this limitation. The nonsteroidal MRAs have been studied in patients with heart failure with reduced ejection fraction, hypertension, and to lower the risk of cardiac and renal outcomes in those with type 2 diabetes and renal disease. In this review, the pharmacology of the MRAs is compared, the data evaluating the use of nonsteroidal MRAs are examined, and the place of this new generation of therapy is discussed. At this time, it seems that there could be a future role for nonsteroidal MRAs to reduce the risk of renal outcomes in high-risk individuals.

Effects of metoprolol on serum inflammatory factors and myocardial ischemia in rats modeled with coronary heart disease

OBJECTIVE

This study was designed to observe the effects of metoprolol on serum inflammatory factors, cardiac function and oxidative stress response in rats modeled with coronary heart disease (CHD).

METHODS

Thirty clean SD rats aged 6-8 weeks were randomized into a control group (CG), treatment group (TG) and model group (MG), with 10 in each group. Rats in the CG were fed regular chow, while those in the MG and TG were fed a high-fat diet. After successful CHD modeling, those in the TG were given metoprolol every day, 10 mg/kg once a day. The effects of cardiac function indexes, myocardial injury indexes, blood lipids, inflammatory factors and oxidative stress indexes, myocardial apoptosis-related factors and apoptosis rate were observed and recorded before and after treatment.

RESULTS

Compared with the CG, the cardiac function indexes of the MG decreased significantly, while the myocardial injury indexes increased markedly. After metoprolol treatment, the cardiac function and myocardial injury of the TG were significantly improved. Also, the expression of serum lipid indexes in the MG increased obviously, and the hyperlipidemia in the TG was improved after metoprolol treatment. Besides, the expression of inflammatory factors in serum of the MG increased remarkably, and metoprolol could reduce the inflammatory state in rats. Furthermore, MDA in serum of the MG increased, SOD, CAT, GSH-Px decreased; revealing that metoprolol can improve oxidative stress in rats. Finally, the apoptosis rate of cardiomyocytes in the MG increased dramatically. Metoprolol treatment can reduce the apoptosis rate and improve the expression of apoptosis related proteins.

CONCLUSION

Metoprolol reduces the degree of myocardial injury, inhibits inflammatory reaction and oxidative stress in vivo, reduces myocardial apoptosis and improves myocardial ischemia in CHD modeled rats.