Background Microfibrillar-associated protein (MFAP4), initially identified as an extracellular matrix protein, has been demonstrated in multiple human disorders, but it is yet to be discovered following acute coronary syndrome (ACS) in clinical practice. Therefore, this study aimed to investigate the relationship between circulating MFAP4 levels and coronary stenosis in ACS. Methods We performed the study in 148 ACS subjects, including 75 ST-segment elevation myocardial infarction (STEMI), 27 non-ST-segment elevation myocardial infarction (non-STEMI) and 46 unstable angina (UA). Clinical variables were collected and Gensini and Syntax stenosis scoring systems were applied to assess the severity of coronary stenosis. Kaplan–Meier and logistic regression analysis were used to analyze the relationship between MFAP4 and the severity of coronary stenosis or ACS outcomes. Spearman analysis was used to describe the correlation between MFAP4 and clinical parameters. Results Circulating MFAP4 levels were significantly decreased in the STEMI group (0.008 ng/ml) compared with the non-STEMI group (0.014 ng/ml) and UA group (0.019 ng/ml) (p < 0.001). After adjusting for confounding factors, we found that MFAP4 was an independent risk factor for STEMI (odds ratio = 0.395, 95% CI 0.174–0.895, p = 0.026). MFAP4 level was negatively correlated with Gensini score and Syntax score (r = − 0.311 and − 0.211, p < 0.001 and 0.01, respectively). Based on the MFAP4 level of 0.117 ng/ml, ACS patients were divided into two groups: the low-MFAP4 group (< 0.117 ng/ml, n = 60) and the high-MFAP4 group (≥ 0.117 ng/ml, n = 88). After the median follow-up of 165 days, Kaplan–Meier survival analysis revealed that the MACE-free rate was significantly lower in ACS patients with lower MFAP4 levels (p = 0.009). Conclusions MFAP4 has a potential as a biomarker for the degree of coronary stenosis in ACS. Confirmation of observations in larger cohorts and longer follow-up periods is warranted.
In order to explore the proteomic signatures of epicardial adipose tissue (EAT) related to the mechanism of heart failure with reduced and mildly reduced ejection fraction (HFrEF/HFmrEF) and heart failure (HF) with preserved ejection fraction (HFpEF), a comprehensive proteomic analysis of EAT was made in HFrEF/HFmrEF (n = 5) and HFpEF (n = 5) patients with liquid chromatography–tandem mass spectrometry experiments. The selected differential proteins were verified between HFrEF/HFmrEF (n = 20) and HFpEF (n = 40) by ELISA (enzyme‐linked immunosorbent assay). A total of 599 EAT proteins were significantly different in expression between HFrEF/HFmrEF and HFpEF. Among the 599 proteins, 58 proteins increased in HFrEF/HFmrEF compared to HFpEF, whereas 541 proteins decreased in HFrEF/HFmrEF. Of these proteins, TGM2 in EAT was down‐regulated in HFrEF/HFmrEF patients and was confirmed to decrease in circulating plasma of the HFrEF/HFmrEF group (p = 0.019). Multivariate logistic regression analysis confirmed plasma TGM2 could be an independent predictor of HFrEF/HFmrEF (p = 0.033). Receiver operating curve analysis indicated that the combination of TGM2 and Gensini score improved the diagnostic value of HFrEF/HFmrEF (p = 0.002). In summary, for the first time, we described the proteome in EAT in both HFpEF and HFrEF/HFmrEF and identified a comprehensive dimension of potential targets for the mechanism behind the EF spectrum. Exploring the role of EAT may offer potential targets for preventive intervention of HF.
Background: The incidence of hyperbilirubinemia after off-pump coronary artery bypass grafting (OPCAB) is unclear. This study aimed at retrospectively analyzing the incidence and character of perioperative hyperbilirubinemia in patients undergoing OPCAB, to analyze the independent risk factors, to identify the correlation with adverse events and mortality, and to explore the management strategy of perioperative hyperbilirubinemia.Methods: Clinical data for 416 patients (314 males and 102 female), who had been subjected to off-pump coronary artery bypass grafting in the Department of Cardiac Surgery, Beijing Chaoyang Hospital from December, 2016 to March, 2019 were recorded. Hyperbilirubinemia was defined as serum total bilirubin ≥ 34.2 μmol/L within 5 days after surgery. Based on the occurrence of hyperbilirubinemia, patients were divided into the normal serum total bilirubin group and the hyperbilirubinemia group. Perioperative variables between the two groups were compared by univariate logistic regression analysis. Multivariate logistic regression analysis was used to analyze variables with statistical significance. Then, we determined the independent risk factors for hyperbilirubinemia after OPCAB. Moreover, incidences of adverse events, length of ICU stay, time of mechanical ventilation and mortality rates between the two groups were compared. Results: Thirty two of 416 patients were found to exhibit postoperative hyperbilirubinemia. The incidence rate was 7.7%. Based on univariate regresssion analysis, differences in gender, preoperative total bilirubin levels, perioperative IABP implantation, perioperative blood transfusion between the two groups were significant. Multivariate logistic regression analysis revealed that elevated preoperative serum total bilirubin levels (OR=1.241, p<0.001), perioperative blood transfusion (OR=0.237, p=0.002) and perioperative IABP implantation (OR=0.238, p=0.003) were independent risk factors for hyperbilirubinemia after OPCAB. Compared to the normal bilirubin group, incidences of new acute renal failure, continuous renal replacement therapy, perioperative myocardial infarction, pulmonary infection, multiple organ dysfunction syndrome and in-hospital mortality in the hyperbilirubinemia group were significantly increased.Conclusions: Perioperative hyperbilirubinemia is associated with adverse events and mortality. In clinical practice, changes in serum total bilirubin levels among patients undergoing OPCAB should be routinely monitored, and active as well as early interventions in patients with risk factors performed. In this manner, postoperative complications can be reduced, thereby improving patient prognosis.
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