Abstract:Renal arterial stenosis (RAS) hypertension is one of the common types of secondary hypertension. The main clinical manifestations are increased levels of renin and aldosterone, abnormal renal function and refractory hypertension that is difficult to control by drugs. In this paper, a case with refractory hypertension due to atherosclerotic renal artery stenosis was reported and the relevant literature was reviewed. The patient was a middle-aged male who could not control his blood pressure within the ideal range despite oral administration of amlodipinebesylate, terazosinhydrochloride, irbesartan, carvedilol, metoprololsuccinate, diltiazium hydrochloride and other drugs, requiring continuous pumping of nitroglycerin to lower blood pressure. Furthermore, the examination of renal artery angiography revealed severe stenosis at the origin of the left renal artery. After stent implantation at the renal artery stenosis, blood pressure could be controlled to the standard by oral administration of terazosin hydrochloride, amlodipine besylate and diltiazem hydrochloride only. There are many reasons leading to secondary hypertension. This paper discusses the common causes of renal artery stenosis as a starting point, in order to deepen the understanding of secondary hypertension and reduce the occurrence of missed diagnosis or misdiagnosis.

Abstract:Aim To investigate the clinical value of real-time three-dimensional echocardiography (RT-3DE) combined with autostrain right ventricle (RV) technology in evaluating right ventricular function in patients with coronary heart disease (CHD)involving the right coronary artery stenosis. Methods A total of 132 patients with suspected CHD were enrolled. According to the results of coronary angiography, they were divided into control group without coronary artery stenosis of 50%, CHD without involving the right coronary artery stenosis group (simple CHD group), CHD involving the right coronary artery stenosis group. The three groups of subjects were analyzed by conventional echocardiography, autostrain RV technology and RT-3DE. Results Compared with control group, at the basal levels of the right ventricular free wall-longitudinal strain (Basal RVFWSL), at the middle levels of the right ventricular free wall-longitudinal strain (Medial RVFWSL), at the apical levels of the right ventricular free wall-longitudinal strain (Apical RVFWSL), right ventricular free wall-longitudinal strain (RVFWSL), right ventricular 4 chamber longitudinal strain (RV4CSL), right ventricular ejection fraction (RVEF), right ventricular stroke volume (RVSV) and right ventricular stroke volume index (RVSVI) were decreased, while right ventricular end-systolic volume (RVESV), right ventricular end-systolic volume index (RVESVI) were increased in simple CHD group and CHD involving the right coronary artery stenosis group. The differences were statistically significant (all P＜0.05). ROC curve analysis showed that RVFWSL of two-dimensional speckle tracking imaging (2D-STI) and RVEF of RT-3DE had higher diagnostic efficiency, with a sensitivity of 90.9% and a specificity of 95.3%. Conclusions RT-3DE combined with autostrain RV technology can improve the accuracy of evaluating right ventricular dysfunction in patients with CHD involving the right coronary artery stenosis, which provides a basis for early clinical treatment and has good application value.

Abstract:Aim To investigate the relationship between carotid artery perivascular fat density and carotid artery stenosis, prognosis. Methods A total of 209 consecutive patients with extracranial internal carotid artery stenosis in Taizhou Central Hospital (Taizhou University Affiliated Hospital) were retrospectively included from January 2017 to January 2021. The carotid artery perivascular fat density in the narrowest axial layer and in the same contralateral axial layer was evaluated by computed tomography angiography. Clinical data of patients were collected. The stenosis was graded according to the guidelines. Symptomatic carotid stenosis was determined according to the medical history. The patients were followed up for one year. Results Carotid artery perivascular fat density was 4.2% higher on the stenosis side than those on the opposite side (P＜0.001). The fat density increased with the stenosis severity. On the stenosis side, carotid artery perivascular fat density was 6.25% higher in symptomatic patients than that in asymptomatic patients (P＝0.015). In asymptomatic patients, perivascular fat density in patients with stenosis related cerebrovascular events occurred within 1 year was 12.4% higher than that in patients without related cerebrovascular events (P＝0.017), and the difference remained after adjusting the clinical parameters by Logistic regression analysis (OR＝1.060,95%CI:1.006～1.117,P＝0.028). Conclusions Carotid artery perivascular fat density is positively correlated with the degree of carotid stenosis. Patients with symptomatic carotid artery stenosis or recurrent related ischemic cerebrovascular outcome events have higher carotid artery perivascular fat density.

Abstract:Aim To investigate the effects of coronary artery stenosis on cardiac pathology and myocardial metabolomics in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Coronary and ventricular sites (anterior, lateral and posterior walls of left ventricle and anterior, posterior wall of right ventricle and interventricular septum) were studied in 35 patients with ARVC undergoing heart transplantation. Coronary artery tissue sections were stained with HE and the degree of stenosis was quantitatively analyzed; slices of ventricular tissue were stained with Masson staining, and the proportion of myocadium, fiber, and adipose tissue in the heart was quantitatively analyzed after image processing. Metabolite extraction and metabolomics analysis of cardiac tissue from coronary artery supply areas were performed. Comparative analysis was conducted on the differences in myocardium, fiber and adipose tissue, and metabolomic profiles among the group of patients without coronary artery stenosis, with mild coronary artery stenosis (＜50%) and with moderate-severe coronary artery stenosis (≥50%). Results Among the 35 patients with ARVC, 10 (28.6%) had moderate-severe coronary artery stenosis, 11 (31.4%) had mild coronary artery stenosis, and 14 (40.0%) had no coronary artery stenosis. The age of patients with moderate-severe coronary artery stenosis receiving heart transplantation was significantly higher than those with mild coronary artery stenosis and those without coronary artery stenosis [(48.5±10.7) years vs. (33.8±10.5) years and (31.0±13.4) years, P＝0.015]. There was no statistically significant difference in the proportion of myocardium, fiber and adipose tissue between patients with moderate-severe, mild coronary artery stenosis and those without coronary artery stenosis in the left ventricular anterior wall, lateral wall, posterior wall, and right ventricular anterior wall, posterior wall, and interventricular septum (P＞0.05). There were 105 metabolites were detected from the metabolic profiles, which attributed to pathways of tricarboxylic acid cycle, amino acid metabolism, purine metabolism, pyrimidine metabolism, pentose phosphate metabolism, glycolysis and gluconeogenesis. Metabolomic analysis showed few differences among the three groups. There was no significant separation of the three groups on heat or in principle component analysis. Conclusion There was no difference in the proportion of myocardium, fiber and adipose tissue of the heart and metabolomic profiles among ARVC patients with moderate-severe, mild coronary artery stenosis and without coronary artery stenosis.

Abstract:Aim To investigate the value of cranial computed tomography perfusion (CTP) imaging in evaluating conservative treatment response in patients with severe carotid artery stenosis (CAS). Methods A total of 90 patients with severe CAS were selected as the research subjects, all received conservative treatment, and they were divided into low response group and high response group according to whether cerebral ischemic disease occurred within 1 year. Regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), regional mean transit time (rMTT), and regional time to peak (rTTP) were compared between the two groups. Cox regression model was used to analyze the independent risk factors of conservative treatment responsiveness, and nomogram was used to analyze the value of rCBV, rCBF, rTTP and rMTT in evaluating conservative treatment responsiveness, and the decision curve and clinical impact curve were verified. Results Of the 90 patients with severe CAS, 2 cases dropped out after 1 year of follow-up, and 88 cases were effectively followed up. There were 65 cases without cerebral ischemia-related complications (in the high response group) and 23 cases with cerebral ischemic diseases (in the low response group), including 15 cases of transient ischemic attacks (17.05%) and 8 cases of cerebral infarction (9.09%). After 3 months of treatment, the rCBF in the two groups was greater than that before treatment, and the rMTT and rTTP were lower than those before treatment (P＜0.05). Before treatment and 3 months after treatment, the rCBF of the low response group was lower than that of the high response group, and the rMTT and rTTP of the high response group were higher than those of the high response group (P＜0.05). The Cox regression model was used to screen out systolic blood pressure, uric acid, rCBF, rMTT and rTTP, and construct a nomogram prediction model for conservative treatment response in patients with severe CAS. The consistency index was 0.896. Calibration curve analysis showed that the prediction model predicted conservative treatment response was in good agreement with the actual conservative treatment response. Within a threshold range of 0.16 to 0.95, the net benefit rate of the combined nomogram model in assessing responsiveness to conservative treatment in patients with severe CAS was superior to testing alone. The number of people classified as high risk by the joint detection scheme and the number of true positive cases were basically the same when the threshold probability was 0.41. Conclusion CTP imaging parameters are closely related to treatment responsiveness in patients with severe CAS, and they can provide a reference for early clinical evaluation of treatment responsiveness and help ensure patient benefit.

Abstract:Aim To explore the predictive value of the newly defined C-reactive protein (CRP) to albumin ratio (CAR) in determining the degree of coronary artery stenosis compared with other inflammatory markers, such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR). Methods Patients with acute myocardial infarction (n＝203) and patients with non-AMI coronary heart disease (n＝103) hospitalized in the Department of Cardiology of the Peoples Hospital of Xinjiang Uygur Autonomous Region from January 1,8 to January 1,0 were included. According to the syntax score, AMI group was divided into two groups:low Syntax score group (Syntax score≤22 points, n＝124) and high Syntax score group (Syntax score≥23, n＝79). CAR, NLR, PLR and MLR were measured, the levels of CAR, NLR, PLR and MLR in each group were compared, and the relationship between the levels of CAR, NLR, PLR and MLR and the degree of coronary artery stenosis was evaluated.. Results The levels of CAR, NLR, PLR and MLR in AMI group were significantly higher than those in non-AMI group (P＜0.001). Correlation analysis showed that CAR was significantly correlated with Syntax score (r＝0.634, P＜0.001), while NLR, PLR and MLR were low correlated with Syntax (r＝0.304, P＜0.001; r＝0.463, P＜0.001; r＝0.344, P＜0.001). Logistic regression analysis showed that CAR level was the only independent risk factor for high Syntax score (OR＝1.8,5%CI:1.004～1.161, P＝0.038). Conclusion The level of inflammatory marker CAR is correlated with the degree of coronary artery stenosis, which can be used as a reliable marker to predict the degree of coronary artery stenosis in AMI patients.

Abstract:Aim To investigate the relationship between serum apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1), creatine kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI) levels and the degree of coronary artery stenosis in patients with coronary heart disease (CHD). Methods 120 patients with CHD were selected as the CHD group, and 40 healthy people who underwent a physical examination during the same period were selected as the normal group. The differences of ApoB/ApoA1, CK-MB and cTnI between normal group and CHD group were compared. In addition, patients in the CHD group were divided into three groups of mild, moderate, and severe coronary artery disease according to the Gensini scores, 25 cases, 52 cases, and 43 cases in each group, respectively. The differences of ApoB/ApoA1, CK-MB and cTnI in CHD patients with different stenosis degrees were compared. In addition, Spearman method was used to analyze the correlation between ApoB/ApoA1, CK-MB and cTnI levels and the degree of coronary artery stenosis. Results The levels of ApoB/ApoA1, CK-MB and cTnI in the CHD group were evidently higher than those in the normal group (P＜0.05). The levels of ApoB/ApoA1, CK-MB and cTnI in the moderate CHD group were evidently higher than those in the mild CHD group (P＜0.05), and the severe CHD group were evidently higher than those in the mild and moderate CHD groups (P＜0.05). ApoB/ApoA1, CK-MB and cTnI levels were positively correlated with the degree of coronary artery stenosis (r＝0.4,0.0,0.930, P＜0.05). Conclusion The levels of serum ApoB/ApoA1, CK-MB and cTnI in patients with CHD are positively correlated with the degree of coronary artery stenosis.

Abstract:Aim To explore the correlation between remnant cholesterol and severity of coronary artery stenosis in patients with prehypertension based on Gensini score. Methods The clinical data of 36 216 coronary angiography patients hospitalized in the Department of Cardiovascular Medicine of Northern Theater Command General Hospital from 2004 to 2014 were retrospectively analyzed, including 421 patients with prehypertension. There were 85 patients with Gensini score ≥20, and 85 patients with Gensini score <20 in this cohort were selected as the control group. The clinical characteristics of the two groups were observed and the relationship between remnant cholesterol and common blood lipid indexes and the degree of coronary artery stenosis in prehypertensive patients was investigated. The seventh report of the National Joint Committee on the prevention, detection, evaluation, and treatment of hypertension in the United States defines prehypertension as systolic blood pressure of 120 to 139 mmHg(1 mmHg＝0.133 kPa) and/or diastolic blood pressure of 80 to 89 mmHg. The European Atherosclerosis Society (EAS) defines remnant cholesterol as total cholesterol－(high density lipoprotein cholesterol＋low density lipoprotein cholesterol). Remnant cholesterol is the amount of cholesterol in triglyceride-rich lipoprotein. Results In the Gensini score≥20 group, the proportion of diabetic patients and left ventricular ejection fraction were higher than those in the Gensini score＜20 group, the difference was statistically significant (P＜0.05). In terms of lipid-related indicators, the levels of remnant cholesterol, triglyceride and total cholesterol in Gensini score≥20 group were higher than those in the Gensini score＜20 group, the differences were statistically significant (P＜0.05). The correlation analysis of remnant cholesterol and triglyceride in Gensini score≥20 group was conducted. The results showed that there was a correlation between remnant cholesterol and triglyceride (r＝0.535, P＜0.01).Subsequently, patients with triglyceride≥1.7 mmol/L were screened for further correlation analysis, and the results showed that the correlation between remnant cholesterol and triglyceride increased further (r＝0.625, P＜0.01). Logistic regression showed that remnant cholesterol (OR＝8.0,5%CI:2.87～27.53, P＜0.01), low density lipoprotein cholesterol (OR＝3.6,5%CI:1.93～6.57, P＜0.01) and diabetes mellitus (OR＝2.4,5%CI:1.10～5.00, P＜0.05) were significantly associated with severe coronary artery stenosis. Conclusion Remnant cholesterol, low density lipoprotein cholesterol, diabetes mellitus and other factors are closely related to the occurrence of severe coronary artery stenosis in patients with prehypertension complicated with coronary heart disease.

Abstract:Aim To study vertebral artery stenosis and its relationship with posterior circulation cerebral infarction after vertebral artery stenting (VAS), and to explore the risk factors of posterior circulation cerebral infarction. Methods Volume computed tomographic digital subtraction angiography (VCTDSA) was used to evaluate the vertebral artery stenosis in 134 patients with posterior circulation ischemia (PCI) after VAS. The patients were divided into two groups:45 cases in PCI symptom with vertebral artery stenosis group (PCI-V group) and 89 cases in simple PCI symptom group (PCI group). The correlation between vertebral artery stenosis and posterior circulation cerebral infarction was analyzed statistically, and the risk factors of posterior circulation cerebral infarction after VAS were analyzed by univariate analysis and multivariate analysis. Results In PCI-V group, there were 51 vertebral artery stenosis sites with an average stenosis rate of (82.1%±6.7%), including 6 cases of mild stenosis, 13 cases of moderate stenosis, 20 cases of severe stenosis and 6 cases of complete occlusion. There was significant difference in the incidence of posterior circulation cerebral infarction between PCI-V group and PCI group (χ2＝10.600, P＝0.001). The incidences of posterior circulation cerebral infarction of patients with moderate stenosis, severe stenosis and complete occlusion in PCI-V group were significantly higher than that of patients in PCI group (all P＜0.05). The results of univariate analysis showed that NIHSS score≥12, hyperhomocysteinemia and diabetes history were the risk factors for posterior circulation cerebral infarction in PCI-V patients. Logistic multivariate analysis showed that NIHSS score≥12, hyperhomocysteinemia and diabetes history were independent risk factors for posterior circulation cerebral infarction in PCI-V patients. Conclusions Posterior circulation cerebral infarction after VAS is related to vertebral artery stenosis. NIHSS score≥12, hyperhomocysteinemia and diabetes history are independent risk factors of posterior circulation cerebral infarction in patients with PCI and vertebral artery stenosis after VAS.

Abstract:Aim To study the relations of serum γ-glutamyl transferase (γ-GT) level with coronary artery calcification and stenosis in patients with hypertension. Methods 145 patients with hypertension from January 2015 to June 2018 were selected as hypertension group, and 60 cases with normal blood pressure at the same period were set as normotensive group. The serum γ-GT level was compared between the two groups. According to the results of spiral CT coronary angiography and coronary artery calcification score (CACS), patients in hypertension group were divided into mild calcification group, moderate calcification group and severe calcification group; according to the degree of coronary stenosis, patients were divided into severe stenosis group, moderate stenosis group and mild stenosis group. The levels of serum γ-GT were compared in each group. Results The level of serum γ-GT in hypertension group was significantly higher than that in normotensive group (P＜0.05); with the increase of hypertension grade, the level of serum γ-GT increased (P＜0.05). The level of serum γ-GT and CACS score in patients with different degrees of calcification were significantly different (P＜0.05); with the aggravation of calcification, the level of γ-GT increased (P＜0.05). There were significant differences in the level of serum γ-GT and the degree of stenosis in patients with different degrees of coronary artery stenosis (P＜0.05); with the aggravation of the degree of coronary artery stenosis, the level of γ-GT increased (P＜0.05). The level of serum γ-GT was positively correlated with the score of CACS and the degree of coronary artery stenosis (P＜0.05). Serum γ-GT was an independent risk factor for coronary artery stenosis or calcification in patients with hypertension. Conclusion The level of serum γ-GT is significantly increased in patients with hypertension, and and it is significantly related to the degree of coronary artery calcification and stenosis.