Abstract:The outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been pandemic and become a major global public health emergency. The typical clinical manifestations of coronavirus disease 2019 (COVID-19) are mainly respiratory symptoms, but the induced damage to cardiovascular system has been reported, which cannot be ignored. What cardiovascular damage can SARS-CoV-2 infection cause? What are the involved mechanisms? How to take measures for better prevention and treatment against cardiovascular damage caused by this novel virus infection? How to regulate the use of cardiovascular drugs in patients with cardiovascular disease combined with COVID-19? These unknowns need to be explored urgently. Starting from this issue, a column titled “SARS-CoV-2 infection and cardiovascular injury” is delivered for two consecutive issues. Experts in relevant fields are invited to expound on these questions and report their clinical investigations. The purpose of this column is to deepen the understanding of COVID-19 and its cardiovascular injury and improve the prevention and treatment.

Abstract:Severe viral pneumonia often leads to a series of cardiac injury, leading to cardiac complications such as arrhythmia, myocardial infarction and heart failure, which makes the condition worsen rapidly. At present, the mechanism involved is not completely clear. In this paper, the possible mechanism of cardiac injury caused by severe viral pneumonia will be discussed to provide ideas for clinical treatment.

Abstract:Aim To investigate the changes of myocardial injury and cardiac function in severe patients with coronavirus disease 2019 (COVID-19). Methods Retrospective analysis was performed on the clinical datas of 36 COVID-19 patients. According to clinical classification, the patients were divided into severe group (n＝4) and mild group (n＝32). Collect the patients's general clinical datas and the status of the consolidated basis of cardiovascular disease, the patients' serum creatinie, myoglobin, lactic dehydrogenase(LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), troponin T (cTnT),Nü end of B-type natriuretic peptide (NT-ProBNP), c-reactive protein (CRP) levels, and echocardiography measurements of left ventricular and right ventricular function. Results The in-hospital time in the severe group was significantly longer than that in the mild group (Z＝－3.183, P＝0.001), the incidence of diabetes (χ²=13.056, P＜0.001), the serum levels of myoglobin(t＝5.284,P＜0.001), CK(Z＝－2.267,P＝0.023), CK-MB(Z＝－2.140,P＝0.032), cTnT(Z＝－2.134, P＝0.037), CRP(Z＝－1.892,P＝0.041), NT-ProBNP(Z＝－2.467,P＝0.014) and right ventricular Tei index(t＝5.256,P＝0.023) were significantly higher than those in the mild group. There were no significant differences in LVDd, LVSd, LVEF and left ventricular Tei index between the two groups. Conclusion The morbidity of diabetes in patients with severe COVID-19 was significantly higher than that of patients with mild COVID-19, while patients with severe COVID-19 had some extend of myocardiol injury and impaired right ventricular function.

Abstract:Aim To investigate the clinical characteristics and the dynamic changes of myocardial enzymes in patients with severe/critical coronavirus disease 2019 (COVID-19) with cardiac injury. Methods A total of 18 severe/critical COVID-19 patients in our hospital from January 7,0 to March 1,0 were retrospectively analyzed. According to the detection value of cardiac enzyme or troponin I during hospitalization, patients in the normal range were classified as nonmyocardial injury group (n＝13), and patients with abnormal elevation were classified as myocardial injury group (n＝5). The epidemiological and clinical data of the two groups after admission were compared and analyzed, and laboratory indicators such as blood routine, liver and kidney function, myocardial enzyme, C-reactive protein were analyzed, and the changes of creatine kinase, creatine kinase isoenzyme MB, N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I were dynamically analyzed. Results Of the 18 severe/critical type patients, 27.8% (5/18) had myocardial injury. Compared with the nonmyocardial injury patients, there were no significant differences in age, gender, basic diseases, symptoms and signs, time from onset to hospitalization, body temperature, heart rate, diastolic blood pressure and hospital stay in the myocardial injury group, but the systolic blood pressure in the myocardial injury group was significantly higher than that in the nonmyocardial injury group(P＝0.017 1). There was no significant difference in white blood cell count, neutrocyte count, lymphocyte count and mononuclear cell count between the two groups upon admission. Similarly, there was no significant difference between the two groups in alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, creatine kinase, creatine kinase isoenzyme MB, blood urea nitrogen, serum creatinine, C-reactive protein and NT-proBNP. Dynamic analysis found that in patients with myocardial injury, creatine kinase, creatine kinase muscle-brain isoenzyme, troponin I, and NT-proBNP gradually increased during the 4～5 days of hospitalization, and gradually returned to normal after 9～11 days. Conclusions Higher systolic blood pressure in patients with severe/critical COVID-19 may be associated with higher risk of heart injury.Abnormalities in myocardial enzyme spectrum occur in the early stage of hospitalization. Early detection and intervention are beneficial to the prognosis of patients with heart injury.

Abstract:Since December 2019, the 2019 novel coronavirus (2019-nCoV) has been raging around the world and causing global panic. 2019-nCoV infection not only leads to lung injury, but also causes myocardial damage in a considerable proportion of patients, which worsens the state of illness and associates with poor prognosis. Heretofore little is known about the characteristic of myocardial damage induced by 2019-nCoV infection. Therefore, this paper will focus on the features, pathological mechanism, prevention and treatment of myocardial damage caused by 2019-nCoV.

Abstract:novel coronavirus (2019-nCoV) invades cells with angiotensin converting enzyme 2 (ACE2) as a receptor to cause infection, and the result of “cytokine storm” is the significant reason inducing coronavirus disease 2019 (COVID-19)s outbreak and death. Clinical data shows that 2019-nCoV is not only involved in the respiratory system, but also accompanied by heart injury, such as acute myocardial injury, arrhythmia and fulminant myocarditis. This review mainly describes the main manifestations, mechanism and prevention strategies of heart injury caused by 2019-nCoV.

Abstract:Novel coronavirus pneumonia may cause cardiac damage, and patients with novel coronavirus pneumonia and underlying cardiovascular diseases have a significantly worse prognosis. In view of the impact of new coronavirus pneumonia on the cardiovascular system, the relationship between them and the understanding of the pathogenesis of Chinese medicine were elaborated to provide systematic guidance for the prevention and treatment of Chinese medicine.

Abstract:Aim To study the effect of miR-223 on vascular inflammation and atherosclerosis, and to provide a new therapeutic target for clinical arteriosclerosis. Methods The miR-223 knockout mice and ApoE knockout mice (ApoE KO) were crossbred to prepare miR-223/ApoE double knockout mice (miR-223/ApoE DKO). The plasma lipid levels of 8-month-old mice were measured. Plaque content in the aortic root and the entire length of the blood vessel were analyzed; Immunohistochemical staining was adapted to detect inflammatory cell infiltration in the plaque; Transcriptomics sequencing was used to analyze the expression of inflammation-related genes in the blood vessel; Screening the microRNA target gene database to find and validate possible target genes. Results Atherosclerosis in aortic root of miR-223/ApoE DKO mice were significantly increased (P<0.05). Immunohistochemical staining showed that more inflammatory cells infiltrated in aortic root of DKO mice; Vascular transcriptomics sequencing revealed that expression of inflammatory genes such as vascular adhesion molecule-1(VCAM-1), interleukin-1α(IL-1α) were up-regulated in DKO mice; Through screening of target genes from database, IL-6 was found to be a potential target gene of miR-223 and its expression was significantly up-regulated in DKO mice; 3T3 cells were transfected with miR-223 mimics and the expression of interleukin-6(IL-6 )was significantly down-regulated. Conclusions miR-223 inhibits the expression of target gene IL-6 and reduces the inflammatory response. Knockout miR-223 significantly increases the level of vascular inflammation and promotes the progression of atherosclerosis.

Abstract:Aim To investigate the effect of serum Nε-carboxymethy lysine (CML) on different degrees of carotid calcification in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). MethodsFrom January 2016 to June 7,6 patients were selected from the Affiliated Hospital of Jiangsu University, including 148 T1DM patients, 191 T2DM patients and 167 patients without diabetes. Color Doppler ultrasound was used to detect bilateral carotid arteries in all patients. The severity of carotid calcification was evaluated according to 0-8 points. The patients were divided into low calcification group (scores:1-4) and high calcification group (scores:5-8). The general clinical data, physical examination results and laboratory examination results were recorded, and the serum CML level was measured by enzyme-linked immunosorbent assay. Multivariate Logistic regression analysis was conducted to determine independent predictors of carotid calcification in T1DM and T2DM patients. During follow-up, CML was retested and major adverse cardiac and cerebrovascular event (MACCE) were followed up. Results In the high calcification group and low calcification group, the CML, carotid intima-media thickness and low density lipoprotein cholesterol level of diabetic patients were higher than those of non-diabetic patients (P＜0.05), and the levels of T2DM patients were higher than levels of T1DM patients (P＜0.05). Multivariate Logistic regression analysis showed that CML was an independent predictor of carotid calcification degree in T1DM patients (OR 2.5,5%CI 1.368-2.996, P＜0.05), and also an independent predictor of carotid calcification degree in T2DM patients (OR 2.5,5%CI 1.481-4.171, P＜0.05). The significant increase of CML during follow-up was correlated with MACCE. Conclusion CML is an independent predictor of different degrees of carotid calcification in T1DM and T2DM patients, and to some extent, it can predict the occurrence of diabetic cardiovascular and cerebrovascular events.

Abstract:Aim To investigate the clinical and pathological features of chronic kidney disease (CKD) 1-2 stage in chronic glomerulonephritis elderly patients with dyslipidemia, and to evaluate the effect of dyslipidemia on CKD. Methods A total of 111 elderly patients who underwent renal biopsy and were eligible for CKD1-2 with primary chronic glomerulonephritis from 2014 to 2017 were enrolled. According to the presence of hyperlipidemia, they were divided into hyperlipidemia group (HL Group) of 76 patients, and non-hyperlipidemia group (non-HL group) of 35 patients, the general data, clinical and pathological features of two groups were reviewed. Results (1) There were no significant differences in age, sex ratio, body mass index, prevalence of hypertension, pathological distribution, serum creatinine, and high-sensitivity C-reactive protein between the two groups. The levels of serum uric acid, 24 h urine protein, urinary transferrin, urinary albumin, urinary α1 microglobulin and urinary NAG were higher in the HL group than in the non-HL group, and serum albumin was lower than that in the non-HL group (P＜0.05). (2) The vascular injury scores of HL group was higher than that of non-HL group (P＜0.05), but the scores of glomerular sclerosis, proportion of crescent, mesangial hyperplasia and tubular injury were not statistically different. (3) By binary variable correlation analysis, 24 h urine protein and urinary transferrin were associated with serum cholesterol, triglyceride, low density lipoprotein, and high density lipoprotein; blood uric acid and urinary albumin were associated with serum cholesterol, triglycerides and low density lipoprotein; serum albumin and urinary NAG enzymes were associated with serum cholesterol, triglycerides, and low-density lipoprotein. Conclusion The CKD 1-2 elderly patients with chronic glomerulonephritis associated with dyslipidemia are more likely to get more severe urinary protein and tubule injury, and have higher risk of getting renal microvascular disease.

Abstract:Aim To explore relationship between serum pentraxin 3(PTX-3), progranulin(PGRN) and blood pressure variability in essential hypertension patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods 241 cases of essential hypertension patients with OSAHS were selected as the observation subjects. According to the apnea hypopnea index(AHI) (mild:AHI 5~15 times/h; moderate:AHI 16~0 times/h; severe:AHI>31 times/h), the patients were divided into mild group (n=136), moderate group (n=45) and severe group (n=60). The baseline data, serum PTX-3 and PGRN, blood pressure variability and the correlation between serum factors and blood pressure variability were compared and analyzed. Pearson and muti-line regression were employed to analyse the relationship between PTX-3, PGRN and blood pressure variability. Results There were significant differences in serum PTX-3 and PGRN levels among the three groups (P<0.05), and there were significant differences in night blood pressure variability among the three groups (P<0.05). Serum PTX-3 was positively correlated with night systolic blood pressure standard deviation(nSSD) (r=0.484, P<0.001) and night diastolic blood pressure standard deviation(nDSD) (r=0.349, P<0.001). Serum PGRN was positively correlated with nSSD (r=0.361, P<0.001) and nDSD (r=0.301, P<0.001). PTX-3 and PGRN were independent risk factors for nSSD and nDSDD. Conclusion Serum PTX-3 and PGRN were positively correlated with nocturnal blood pressure variability in essential hypertension patients with OSAHS. Serum level of PTX-3 and PGRN were independent risk factors of nocturnal blood pressure variability.

Abstract:Aim To investigate the influencing factors of quality of life in patients with hypertensive cerebral hemorrhage in the basal ganglia after minimally invasive hematoma evacuation. Methods A retrospective analysis of 80 patients with hypertensive cerebral hemorrhage in the basal ganglia with minimally invasive hematoma evacuation in our hospital from January 2012 to January 2015 was performed, a single factor analysis of the factors affecting postoperative quality of life and Logistic regression analysis was performed to investigate the independent influencing factors of quality of life in patients with hypertensive cerebral hemorrhage in the basal ganglia undergoing minimally invasive puncture hematoma evacuation. Results Univariate analysis showed that the patient age, family size, marital status, education level, family monthly income, midline shift, cerebral hemorrhage, cerebral palsy and cerebral ventricle, and patient consciousness have significant effects on postoperative physical health of patients (P<0.05); family size, whether living with children, marital status, and state of consciousness were significant factors affecting postoperative mental health (P<0.05); multivariate analysis showed that the number of family members (OR=1.1,5% CI 1.175~3.206) and midline displacement (OR=0.9,5% CI 0.363~0.956), cerebral hemorrhage (OR=10.3,5% CI 6.099~ 17.235) is an independent influencing factor affecting postoperative physical health; marital status (OR=0.7,5% CI 0.357~0.664) and whether or not living with children (OR=5.2,5% CI 5.145~5.652) is affecting patients independent influence factors of post-mental health. There was a significant negative correlation between family size, midline displacement, and cerebral hemorrhage and physical health scores. Marriage status was significantly negatively correlated with mental health scores, and positively correlated with children's living and mental health scores. Conclusion The quality of life of patients with hypertensive cerebral hemorrhage in the basal ganglia is significantly related to the patient's family size, brain midline shift, cerebral hemorrhage, and whether they live with their children or marital status.

Abstract:Aim To study the predictive value of serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) for cardiovascular adverse events after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods The patients diagnosed as acute STEMI receiving emergency PCI in our hospital from May 2017 to May 2019 were selected for retrospective study. Cardiovascular adverse events including death, myocardial infarction, ventricular arrhythmia and cerebrovascular accident were evaluated after PCI.Then the influencing factors for cardiovascular adverse events and the predictive value of serum sTWEAK were analyzed after PCI. Results Among the 100 patients, 14 patients had cardiovascular adverse events after PCI, and the incidence was 14%. Univariate analysis showed that compared with the patients without cardiovascular adverse events after PCI, the incidence of diabetes, white blood cell count, blood glucose, hypersensitive C-reactive protein, creatine kinase-MB (CK-MB) peak value, the proportion of multi vessel lesions and the content of sTWEAK increased, the time from the onset to PCI prolonged, the proportion of tirofiban use, the proportion of thrombus aspiration and TIMI grade after treatment decreased, in the patients with cardiovascular adverse events after PCI. Logistic regression analysis showed that diabetes mellitus, CK-MB peak value, sTWEAK, tirofiban use and thrombus aspiration were the influencing factors of cardiovascular adverse events after PCI. The best cut-off point of serum sTWEAK in predicting cardiovascular adverse events after PCI was 68.5 ng/L, and the sensitivity and specificity were 62.35% and 71.43% respectively. Conclusion The increase of serum sTWEAK in patients with acute STEMI at admission has a predictive value for cardiovascular adverse events in the hospital after PCI.

Abstract:Aim To study the efficacy of rotational atherectomy (RA) versus balloon pre-dilated combined with drug eluting stent(DES) implatation in the treatment of heavily calcified coronary lesions. Methods The study selected patients with heavily calcified coronary lesions admitted in Fuyang City People's Hospital from October 2017 to October 2018 who were going to receive PCI. The patients were divided into two groups according to the random number table, which were the RA combined with DES group (observation group, n=32) and the balloon pre-dilated combined with DES(control group, n=40). Prospective randomized controlled study was performed. The treatment characteristics and perioperative complications were compared between the two groups. The risk factors of major adverse cardiovascular and cerebrovascular events (MACCE) within 6 months were analyzed. Results The average stent diameter was significantly higher in the observation group than in the control group (3.25 (3.0,3.50) mm vs 3.00 (2.1,3.25) mm, P=0.002). The number of balloon pre-dilated,pre-dilated maximum pressure, the number of balloon post-dilated and post-dilated maximum pressure were significantly lower in the observation group than in the control group(P＜0.05). The lumen diameter after PCI was significantly larger in the observation group than in the control group((3.34±0.28) mm vs (3.15±0.27) mm, P=0.005). The procedural success rate of the observation group (96.9%) was higher than that of the control group (92.9%), the incidence of total MACCE in the observation group (9.4%) was lower than in the control group (22.5%), but there is no significant differences between the two groups(P＞0.05). The previous PCI(risk ration:1.5,5%CI:0.030～0.691, P=0.015) and the maximum pressure of balloon pre-dilated(risk ration:2.6,5%CI:0.721～0.988, P=0.035) were independent risk factors for MACCE within 6 months. Conclusions For severely calcified coronary lesions with a SYNTAX score of 23 to 32, RA has tendencies to improve the procedural success rate and reduce short-term adverse events. The previous PCI and the maximum pressure of pre-dilated were independent risk factors for MACCE within 6 months.

Abstract:Aim To explore the clinical characteristics and prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) who received drug conservative treatment. Methods The clinical data of 93 elderly patients with acute STEMI who received drug conservative treatment in our hospital from January 2013 to December 2016 were collected retrospectively. The basic clinical data, clinical medication and prognosis of patients were analyzed.The influencing factors of poor prognosis and death were analyzed by Logistic regression model. Kaplan-Meier curve was used to analyze the survival status of elderly patients over time. Results Most of the elderly STEMI patients had hypertension (64 cases, 68.8%) and hyperlipidemia (84 cases, 90.3%). In addition to aspirin and clopidogrel, the use rate of statins in elderly patients with acute STEMI was higher, and reached 89.2%. There were more patients with acute anterior wall myocardial infarction and acute inferior wall myocardial infarction, accounting for 41.9% and 28.0% respectively. The prognosis analysis showed that 33.3% of the patients had a good prognosis within two years, 32.3% of them died in hospital and 23.7% died out of hospital. Multivariate Logistic regression analysis showed that gender was the influencing factor for the poor prognosis of elderly patients with acute STEMI treated with conservative drugs (OR＝3.8,5%CI 1.09-9.26, P＝0.03), and the incidence of poor prognosis in female patients was 3.18 times that in male patients; NYHA cardiac function grade Ⅳ (OR＝67.7,5%CI 2.73-154.50, P＝0.01) and no diuretics using (OR＝0.6,5%CI 0.00-0.95, P＝0.04) were the risk factors of hospital death in elderly patients with acute STEMI. Conclusions In the elderly patients with acute STEMI receiving drug conservative treatment, the prognosis of women is often worse than that of men. NYHA cardiac function grade Ⅳ and no diuretics using are the risk factors of hospital death in elderly patients with acute STEMI.

Abstract:Coronary artery calcification is a risk factor for poor prognosis in patients with coronary atherosclerosis.A variety of factors are associated with the development and progression of coronary artery calcification, including gender, age, persistent inflammatory status, hypertension, hyperlipidemia, and diabetes. In recent years, there has been increasing attention to non-traditional risk factors for coronary artery disease to open up new ideas of the primary prevention of coronary artery calcification. Developing imaging techniques have also helped in the early detection and mechanism of coronary artery calcification. This article will focus on the high-risk factors, mechanisms, inspection method, clinical significance and treatment progress of coronary artery calcification, aiming to improve people's further understanding and attention to coronary artery calcification.

Abstract:As its high morbidity, serious harm, with poor prognosis and high death rate, cardiovascular disease has always been the focus of the world, especially myocardial infarction(MI) with higher mortality, and with increased morbidity year by year, which should be focused on by each patient. Recent years, along with constantly emerging studies of acute infection causing increased risk of myocardial infarction, it attracts the attention of multidisciplinary physicians. This article reviews the progress of acute infection increasing the risk of myocardial infarction.