Cx40 mRNA expression in crista terminalis and left atrium of patients with rheumatic heart disease associated chronic atrial fibrillation

Objectives： To explore possible mechanisms of connexin40 （Cx40） remodeling by detecting Cx40 mRNA expression of the crista terminalis and left atrium （LA） in patients with rheumatic heart disease （RHD） associated chronic atrial fibrillation （AF）. Methods： Twenty patients were enrolled in this study, who underwent surgical operation for RHD-associated mitral disease, including l0 with sinus rhythms （rhythm group） and l0 with AF （AF group）. Another 6 patients with non-RHD sinus rhythms were divided into the control group. A small amount of myocardial tissue was cut from the crista terminalis and the LA posterior wall during the valvular replacement operation. Cx40 mRNA expression was assayed by real-time fluorescent quantitation polymerase chain reaction （RT-PCR）. Results： There was no significant difference in Cx40 mRNA expression in the crista terminalis and LA posterior wall between the 3 groups, and there was no significant difference in Cx40 mRNA expression between the crista terminalis and LA within each group. Conclusion： Based on the finding in previous studies that there existed evident remodeling of atrial Cx40 protein in patients with chronic RHD, the results of the present study suggest that the mechanism of Cx40 remodeling probably lies in the post transcriptional level.

Effectiveness and safety of apixaban and rivaroxaban vs warfarin in patients with atrial fibrillation and chronic kidney disease

BACKGROUND Randomized controlled trials(RCTs)of direct oral anticoagulants(DOACs)included a low proportion of atrial fibrillation(AF)patients with chronic kidney disease(CKD),and suggested that DOACs are safe and effective in patients with mild-to-moderate CKD.In a metanalysis of RCTs and observational studies,DOACs were associated with better efficacy(vs warfarin)in early CKD and had similar efficacy and safety profiles in patients with stages IV-V CKD.But few studies have provided data on the safety and effectiveness of each DOAC vs warfarin in patients with stage III CKD.The effectiveness and safety of DOACs in those patients are still subject to debate.AIM To assess and compare the effectiveness and safety of apixaban and rivaroxaban vs warfarin in this patient population.METHODS A cohort of patients with an inpatient or outpatient code for AF and stage III CKD who were newly prescribed apixaban and rivaroxaban was created using the administrative databases from the Quebec province of Canada between 2013 and 2017.The primary effectiveness outcome was a composite of ischemic stroke,systemic embolism,and death,whereas the primary safety outcome was a composite of major bleeding within a year of DOAC vs warfarin initiation.Treatment groups were compared in an under-treatment analysis using inverse probability of treatment weighting and Cox proportional hazards.RESULTS A total of 8899 included patients filled out a new oral anticoagulation therapy claim;3335 for warfarin and 5564 for DOACs.Compared with warfarin,15 mg and 20 mg rivaroxaban presented a similar effectiveness and safety composite risk.Apixaban 5.0 mg was associated with a lower effectiveness composite risk[Hazard ratio(HR)0.76;95%confidence interval(CI):0.65-0.88]and a similar safety risk(HR 0.94;95%CI:0.66-1.35).Apixaban 2.5 mg was associated with a similar effectiveness composite(HR 1.00;95%CI:0.79-1.26)and a lower safety risk(HR 0.65;95%CI:0.43-0.99.Although,apixaban 5.0 mg was associated with a better effectiveness(HR 0.76;95%CI:0.65-0.88),but a similar safety risk profile(HR 0.94;95%CI:0.66-1.35).The observed improvement in the effectiveness composite for apixaban 5.0 mg was driven by a reduction in mortality(HR 0.61;95%CI:0.43-0.88).CONCLUSION In comparison with warfarin,rivaroxaban and apixaban appear to be effective and safe in AF patients with stage III CKD.

Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.

Pathological study on right atrium myocardium in rheumatic heart disease patients with atrial fibrillation

Objective: To study the pathological basis of right atrial fibrillation in rheumatic heart disease (RHD) patients with atrial fibrillation (AF). Methods: Twenty-nine patients with mitral valve replacement of RHD were divided into AF group (n=13) and sinus rhythm group (SN group) (n=16). There was no significant statistical difference in clinical factors between the 2 groups. During the operation of valve replace-ment, the samples of right atrial appendages were taken and the qualitative and quantitative study were made by light microscopy and electron microscopy. Results: (1) Light microscope: The interstitial fibrosis and the arrangement of myocardium was more disordered in AF group than that in SN group. However, no statistic difference was found in interstitial fibrosis and cellar hypertrophy degree between the 2 groups. (2) Electron microscope: Mitochondrial crosta broke and dissolved obviously in AF group. The mitochondrial volume in AF group was smaller than that in SN group. Volume density, average area and average perimeter in AF group were less than that in SN group ; specific surface in AF group was bigger than that in SN group. There was significant difference of above factors between the 2 groups; but there was no significant difference of surface density and numerical density on area in the 2 groups. Volume density of myofibril in AF group and SN group were less than that in SN group. (3)Split of Intercalated disc(ID) gap was found in AF group, and there was marrowing and floccular substance in ID gap. Conclusion : There were significant differences in the pathological changes of right atrial myocardium between AF and SN with RHD, these changes may be the im-portant pathological basis for RA fibrillation of AF patients with RHD.

Gene Expression of Atrial Calcium - Handling Proteins in Patients with Rheumatic Heart Disease and Atrial Fibrillation

Objectives To investigate the gene expression of calcium - handling proteins in patients with rheumatic heart disease (RHD) and atrial fibrillation (AF) . Methods A total of 50 patients with rheumatic mitral valve disease were included. According to cardiac rhythm and duration of episode of AF, patients were divided into four groups: sinus rhythm group, paroxysmal AF group, persistent AF for less than 6 months group and persistent AF for more than 6 months group. Atrial tissue was obtained from the right atrial appendage, the right atrial free wall and the left atrial appendage respectively during open heart surgery. Total RNA was isolated and reversly transcribed into cDNA. In a semi - quantitative polymerase chain reaction the cDNA of interest and of glyceralde-hyde3 - phosphate dehydrogenase (GAPDH) were amplified and separated by ethidium bromide - stained gel electrophoresis. Multiple liner regress was used for correlation between the mRNA amount and age, sex, right atrial diameter (RAd) and left atrial diameter (LAd) . Results The mRNA of L - type calcium channeled subunit, of Ca2+ - ATPase and of ryanodine receptor in patients with persistent AF for more than 6 months were significantly decreased ( P all < 0. 01) . But no alterations of the mRNA levels for SR phos-pholamban and calsequestrin were observed in patients with persistent AF for more than 6 months compared with patients with sinus rhythm, paroxysmal AF and persistent AF for less than 6 months ( P all > 0. 05) . There was no difference of the gene expression among the three atrial tissue sampling sites (P all > 0. 05) . Age, gender, RAd and LAd had no significant effects on the gene expression of calcium - handling proteins (P all>0. 05). Conclusions The mRNA expression of calcium - handling proteins is down - regulated only in patients with RHD and long - term persistent AF. Such abnormalities may be related to the initiation and/or perpetuation of AF in the patients with RHD.

Feasibility and safety of cryoballoon ablation for atrial fibrillation inpatients with congenital heart disease

BACKGROUND The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PV) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time. AIM To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD. METHODS The study population consisted of consecutive patients with CHD and cryoballoon ablation for AF at the Montreal Heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the pulmonary vein. At least one 240-second cryothermal application was performed upon obtaining complete pulmonary vein occlusion. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and then annually. RESULTS Ten patients, median age 57.9 (interquartile range 48.2-61.7) years, 60% female, met inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) years.Two had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return;aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The pulmonary vein anatomy was normal in 6 (60.0%) patients. Four had left common PV (n = 3) and/or 3 right PV (n = 2). Electrical pulmonary vein isolation (PVI) was acutely successful in all. One patient had transient phrenic nerve palsy that recovered during the intervention. No major complication occurred. One year after a single ablation procedure, 6 (60%) patients remained free from AF. One patient with recurrent AF had recovered pulmonary vein conduction and underwent a second PVI procedure. A second patient had ablation of an extra-pulmonary vein trigger for AF. CONCLUSION Cryoballoon ablation for AF is feasible and safe in patients with simple and moderate forms of CHD, with an excellent acute success rate and modest 1-year freedom from recurrent AF.

Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure

AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers(BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.RESULTS A total of 903 patients were evaluated(mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms(New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia(23% vs 37%), coronary artery disease(28% vs 52%) and left bundle branch block(9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology(50% vs 24%), a history of valve surgery(13% vs 4%) and received overall more devices implantation(31% vs 21%). The use of disease-modifying medications(i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF(72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics(87% vs 69%) and digoxin(51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm(SR)(45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of allcause mortality, the univariate relationship between AF and death(HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant(HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy.CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis.

Bioinformatics Analysis on lncRNA and mRNA Expression Profiles for Novel Biological Features of Valvular Heart Disease with Atrial Fibrillation

The biological features of the valvular heart disease with atrial fibrillation(AF-VHD)remain unknown when involving long non-coding RNAs(lncRNAs).This study performed system analysis on lncRNA and messenger RNA(mRNA)expression profiles constructed by using bioinformatics methods and tools for biological features of AF-VHD.Fold change and t-test were used to identify differentially expressed(DE)lncRNAs and mRNAs.The enrichment analysis of DE mRNAs was performed.The subgroups formed by lncRNAs and nearby mRNAs were screened,and a transcriptional regulation network among lncRNAs,mRNAs,and transcription factors(TFs)was constructed.The interactions between mRNAs related to lncRNAs and drugs were predicted.The 620 AF-VHDrelated DE lncRNAs and 452 DE mRNAs were identified.The 3 lncRNA subgroups were screened.The 665 regulations mediated by lncRNAs and TFs were identified.The 9 mRNAs related to lncRNAs had 1 or more potential drug interactions,totaling 37 drugs.Of these,9 drugs targeting 3 genes are already known to be able to control or trigger atrial fibrillation(AF)or other cardiac arrhythmias.The found biological features of AF-VHD provide foundations for further biological experiments to better understand the roles of lncRNAs in development from the valvular heart disease(VHD)to AF-VHD.

Burden of atrial fibrillation in patients with rheumatic diseases

BACKGROUND Studies have suggested that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to inflammation.determine morbidity and mortality associated with AF in hospitalized patients with RD.METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF.A subgroup analysis was performed comparing outcomes of AF among different RD.RESULTS The prevalence of AF was 23.9%among all patients with RD(n=3949203).Among the RD subgroup,the prevalence of AF was highest in polymyalgia rheumatica(33.2%),gout(30.2%),and pseudogout(27.1%).After adjusting for comorbidities,the odds of having AF were increased with gout(1.25),vasculitis(1.19),polymyalgia rheumatica(1.15),dermatopolymyositis(1.14),psoriatic arthropathy(1.12),lupus(1.09),rheumatoid arthritis(1.05)and pseudogout(1.04).In contrast,enteropathic arthropathy(0.44),scleroderma(0.96),ankylosing spondylitis(0.96),and Sjorgen’s syndrome(0.94)had a decreased association of AF.The mortality,length of stay,and hospitalization costs were higher in patients with RD having AF vs without AF.Among the RD subgroup,the highest mortality was found with scleroderma(4.8%),followed by vasculitis(4%)and dermatopolymyositis(3.5%).CONCLUSION A highest association of AF was found with gout followed by vasculitis,and polymyalgia rheumatica when compared to other RD.Mortality was two-fold higher in patients with RD with AF.

Atrial Arrhythmias Including Atrial Fibrillation in Congenital Heart Disease:Mechanisms,Substrate Identifi cation and Interventional Approaches

Atrial arrhythmias,including atrial fibrillation,in the setting of congenital heart disease(CHD)are epidemiologically and mechanistically different from those encountered in the general population.These arrhythmias occur at younger ages in patients with CHD,and are frequently degenerative and progressive.The epidemiology,incidence,and prevalence of the spectrum of atrial arrhythmias,including atrial fibrillation,vary according to the specific CHD type,prior treatment,and residual and ongoing structural and functional sequelae.The combined impact of incisional scars,abnormal hemodynamics,atrial chamber dilatation,and increases in atrial wall thickness and distribution of fi brosis results in a highly dynamic and continuously changing atrial substrate that is highly predisposed to arrhythmias.Given the multiple substrates,individualized therapeutic plans can include pharmacologic therapy,catheter-based ablation,and surgical therapies performed concomitantly with primary surgical intervention for hemodynamically significant sequelae of CHD.Advanced imaging with CT or MRI can provide valuable information for decision making and procedural planning.Application of novel therapeutic technologies and pharmacologic agents necessitates special considerations when applied to the CHD population and requires greater study in specific subsets of CHD patients.

Expression of PDGFR-α in Patients with Valvular Atrial Fibrillation

Objective: To investigate the expression of Platelet-derived growth factor receptor alpha (PDGFR-α) in patients who have valvular atrial fibrillation. Methods: In this research, eighty-four patients with rheumatic heart disease who were going to undertake cardiac surgery were included. The subjects were divided into two groups: the AF group and the sinus rhythm group, the quantities are 39 and 45 respectively. Before the surgery, baseline demographics, physical examination, routine laboratory testing, echocardiography, echocardiographic data and additional clinical data were available for all patients. The right atrial tissue of the subjects was separated during surgery, with an area of approximately 0.3 - 0.5 mm3. Immunofluorescence staining was used to analyze the distribution of PDGFR-α of atrial tissue. mRNA of PDGFR-α in atrial tissue were determined by real-time quantitative PCR (Polymerase Chain Reaction);Western-Blot technique was used to measure the protein of PDGFR-α in atrial tissue. Results: There were no significant differences (P > 0.05) in sex ratio, age, blood pressure, blood biochemistry, and other aspects of medical history between the two groups. However, the right and left atrium diameters in the AF group were markedly larger than those in the SR group (P α from right atrial tissue were obviously higher in the AF group than that in the SR group (P Conclusion: The expression of PDGFR-α in the right atrial tissue of patients with atrial fibrillation was found to be significantly higher.

Atrial Fibrillation: Epidemiological, Etiological and Hospital Management Aspects in Thies (Senegal)

Introduction: The objective of this work was to describe the epidemiological, etiological, clinical and therapeutic aspects of atrial fibrillation (AF) in Thies, Senegal. Materials and Methods: This was a retrospective, multicentre, descriptive study from February 1st, to May 28th, 2019 carried out in the 3 hospitals of the city of Thies that focused on patients with AF documented by an ECG. Valvular and non-valvular AF classification was used and the CHA2DS2-VASc score was used to assess thromboembolic risk. Results: We collected 67 patients with a female predominance (M/F sex ratio of 0.71). The prevalence of AF was 1.7%. The average age of patients was 66.67 ± 13.48 years. Forty-eight patients (71.64%) had palpitations and 32 patients (47.76%) had heart failure. Hypertension was the most common etiological factor found in 41 patients (61.19%) followed by rheumatic valvular disease in 25 patients (37.31%). The non-valvular AF was found in 42 patients (62.69%) of which 34 (80.95%) had a CHA2DS2-VASc score ≥ 2. Vitamin K antagonists (VKAs) were prescribed in 47 patients (79.66%) and aspirin alone in 12 patients (20.34%). Direct Oral Anticoagulants (DOACs) were not prescribed in any patient. Seven patients (10.44%) had a medical regulator treatment and no electrical cardioversion was performed. Conclusion: AF was a frequent rhythm disorder. Hypertension and rheumatic mitral valve disease were the most frequently associated etiological factors. The diagnosis was often late in the heart failure stage. Anticoagulant treatment was insufficiently prescribed and based exclusively on VKAs.

Update on evidence-based clinical application of sodium-glucose cotransporter inhibitors:Insight to uncommon cardiovascular disease scenarios in diabetes

In this paper,we concentrate on updating the clinical research on sodium-glucose cotransporter inhibitors(SGLTis)for patients with type 2 diabetes who have heart failure with a preserved injection fraction,acute heart failure,atrial fibrillation,primary prevention of atherosclerotic cardiovascular disease/cardiovascular disease,and acute myocardial infarction.We searched the data of randomized controlled trials and meta-analyses of SGLTis in patients with diabetes from PubMed between January 1,2020 and April 6,2024 for our review.According to our review,certain SGLTis(empagliflozin,dapagliflozin,canagliflozin,and tofogliflozin),but not sodium-glucose cotransporter 1 inhibitor(SGLT1i),exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases.Proper utilization of SGLTis in these patients can foster clinical improvement and offer an alternative medication option.However,clinical trials involving SGLTis for certain diseases have relatively small sample sizes,brief intervention durations,and conclusions based on weak evidence,necessitating additional data.These findings are significant and valuable for providing a more comprehensive reference and new possibilities for the clinical utilization and scientific exploration of SGLTis.

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

TLR2 was overexpressed independent of IL-6 in patients with valvular atrial fibrillation

Toll-like receptor 2 （TLR2） has recently been shown to be up-regulated in patients with non-valvular atrial fi-brillation （AF）. The present study was aimed to determine whether the pathogenesis and development of AF is associated with the up-regulation of TLR2. Clinical data and right atrial appendage （RAA） specimens were col-lected from 20 patients with persisten AF （PeAF）, 15 patients with paroxysmal AF （PaAF） and 13 patients with no history of AF undergoing valvular replacement. The results showed that gene expression and protein content of TLR2 were increased in both the AF subgroups, compared with the sinus rhythm （SR） group. Between the two AF subgroups, PaAF had a higher TLR2 level than PeAF. However, no difference in interluekin （IL）-6 content was found among the three groups, and no correlation was found between TLR2 and IL-6 in PeAF patients （r = 0.090, P = 0.706）, PaAF patients （r = 0.408, P = 0.131） and AF patients （r = -0.301, P = 0.079）. Immunohistochemical analysis revealed that TLR2 was distributed in RAAs of AF patients and confirmed the immunoblotting results. In conclusion, we demonstrated that TLR2 was elevated in AF （especially PaAF） patients with valvular heart disease, further implicating inflammation involved in the pathogenesis and development of AF.

Randomized controlled trial of remote ischemic preconditioning and atrial fibrillation in patients undergoing cardiac surgery

AIM To study whether remote ischemic preconditioning(RIPC) has an impact on clinical outcomes, such as post-operative atrial fibrillation(POAF).METHODS This was a prospective, single-center, single-blinded,randomized controlled study. One hundred and two patients were randomized to receive RIPC(3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia) or no RIPC(control). Primary outcome was POAF lasting for five minutes or longer during the first seven days after surgery. Secondary outcomes included length of hospital stay, incidence of inpatient mortality, myocardial infarction, and stroke. RESULTS POAF occurred at a rate of 54% in the RIPC group and 41.2% in the control group(P = 0.23). No statistically significant differences were noted in secondary outcomes between the two groups. CONCLUSION This is the first study in the United States to suggest that RIPC does not reduce POAF in patients with elective or urgent cardiac surgery. There were no differences in adverse effects in either group. Further studies are required to assess the relationship between RIPC and POAF.

参松养心胶囊联合沙库巴曲缬沙坦治疗阵发性心房颤动合并慢性心力衰竭对hs-CRP、BNP、AngⅡ及心功能的影响

目的 探讨参松养心胶囊联合沙库巴曲缬沙坦治疗阵发性心房颤动合并慢性心力衰竭对高敏C反应蛋白(High sensitivity C-reactive protein, hs-CRP)、脑钠肽(Brain natriuretic peptide, BNP)、血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)及心功能的影响。方法 选取100例阵发性心房颤动合并慢性心力衰竭患者,随机分为对照组与观察组,每组50例,对照组在常规治疗基础上给予沙库巴曲缬沙坦口服,观察组在常规治疗基础上给予参松养心胶囊联合沙库巴曲缬沙坦口服治疗,疗程6个月。观察血清hs-CRP、BNP、AngⅡ、左心室射血分数(Left ventricular ejection fraction, LVEF)、左室收缩末期内径(Left ventricular end systolic diameter, LVESD)、左室舒张末期内径(Left ventricular end diastolic diameter, LVEDD)变化。结果 两组治疗前血清hs-CRP、BNP、AngⅡ比较差异无统计学意义(P>0.05),治疗后下降(P<0.05),且观察组低于对照组(P<0.05);两组治疗前LVEF、LVESD、LVEDD比较差异无统计学意义(P>0.05),治疗后LVEF升高(P<0.05),且观察组高于对照组(P<0.05),治疗后LVESD、LVEDD下降(P<0.05),且观察组低于对照组(P<0.05);两组治疗前阵发性心房颤动发作次数、阵发性心房颤动持续时间、心室率比较差异无统计学意义(P>0.05),治疗后下降(P<0.05),且观察组低于对照组(P<0.05);对照组转为持续性心房颤动、心力衰竭恶化、缺血心源性死亡率分别为20.00%、22.00%、4.00%,观察组分别为4.00%、6.00%、0.00%,转为持续性心房颤动、心力衰竭恶化发生率对照组高于观察组(P<0.05);观察组治疗疗效优于对照组(P<0.05)。结论 参松养心胶囊联合沙库巴曲缬沙坦治疗阵发性心房颤动合并慢性心力衰竭有助于促进hs-CRP、BNP、AngⅡ下降,改善患者心功能,改善预后。

肿瘤坏死因子受体3相互作用蛋白2与心房颤动相关性的临床研究

目的探讨肿瘤坏死因子受体3相互作用蛋白2(TRAF3IP2)与心房颤动(下称房颤)的相关性。方法选择南京医科大学附属淮安第一医院2021年6至12月收治的瓣膜性心脏病患者41例,根据是否合并房颤分为房颤组22例和非房颤组19例。收集患者的临床资料、全血以及部分心房肌组织,比较两组患者TRAF3IP2表达水平和纤维化指标[胶原和α平滑肌肌动蛋白(α-SMA)含量]。结果房颤组左心房直径(LAD)、TRAF3IP2表达水平均高于非房颤组(均P<0.01),TRAF3IP2表达与LAD呈直线相关(r=0.33,P=0.037)。分层分析显示在LAD≤3.5 mm的患者中,房颤组TRAF3IP2表达水平高于非房颤组;在LAD>3.5 mm的患者中,房颤组TRAF3IP2表达水平高于非房颤组(均P<0.01)。马松染色和免疫组化染色显示,房颤组心房肌胶原含量及TRAF3IP2表达水平高于非房颤组。Western blotting结果显示房颤组心房肌组织TRAF3IP2和α-SMA表达水平高于非房颤患者。结论TRAF3IP2与房颤存在相关性,具体表现为房颤患者的TRAF3IP2表达水平高于非房颤患者,提示TRAF3IP2可能参与房颤的进展。

阿哌沙班联合双联抗血小板对冠心病合并房颤患者生存质量、心功能及miR-146水平的影响

目的:探讨阿哌沙班联合双联抗血小板治疗对冠心病合并房颤患者生存质量、心功能及miR-146水平的影响。方法:选取92例冠心病合并房颤患者作为研究对象,依据治疗方式将患者分为对照组(华法林联合双联抗血小板治疗,n=46)和观察组(阿哌沙班联合双联抗血小板治疗,n=46),所有患者均连续治疗3个月。比较两组患者的临床疗效、生存质量、心功能、凝血功能、炎症指标及miR-146水平,并记录不良反应发生情况。结果:观察组治疗有效率高于对照组(91.30%vs.76.09%,P<0.05);治疗后,观察组SF-36评分高于对照组[(83.57±6.37)vs.(76.48±6.14),P<0.001],MLWHFQ评分低于对照组[(32.13±4.90)vs.(37.20±5.40),P<0.001];观察组LVEF水平高于对照组[(55.38±6.92)vs.(51.23±6.74),P<0.05];观察组PT、TT及APTT水平均高于对照组(P<0.001);观察组MCP-1、CRP及miR-146水平均低于对照组(P<0.05);观察组出血发生率及不良反应总发生率均低于对照组(P<0.05)。结论:采用阿哌沙班联合双联抗血小板治疗冠心病合并房颤的疗效确切,利于改善患者心功能及凝血功能,并可降低炎症反应程度及出血等不良事件发生风险,有助于提高患者生存质量。

不同心房颤动类型患者合并缺血性卒中的危险因素分析

目的探讨不同心房颤动(房颤)类型患者合并缺血性卒中的危险因素。方法连续入选2016年1月至2021年4月于中国中医科学院广安门医院心内科住院的非瓣膜性房颤患者751例,分为阵发性房颤(367例)和持续性房颤(384例),将不同房颤类型患者分为缺血性卒中组和非缺血性卒中组,分析不同类型房颤合并缺血性卒中的危险因素。结果在房颤合并卒中患者中,持续性房颤患者比例大于阵发性房颤(P<0.05),在阵发性房颤患者中,卒中组合并高血压、冠心病、心力衰竭(心衰)、糖尿病比例高于无卒中组,CHA2DS2-VASc评分高于无卒中组[(5.92±1.41)分比(3.97±1.26)分,P<0.05]。多因素logistics回归分析显示,冠心病(OR=3.795,95%CI 1.011~14.241,P<0.05)、糖尿病(OR=2.121,95%CI 1.272~3.536,P<0.05)是阵发性房颤合并缺血性卒中的独立危险因素。持续性房颤患者中,卒中组女性(P<0.05)、合并高血压(P=0.012)比例高于无卒中组,年龄[(79.34±6.62)岁比(74.5±9.70)岁]、左心房内径(LAD)[(49.28±4.29)mm比(42.13±3.96)mm]、CHA2DS2-VASc评分[(3.97±1.38)分比(3.61±1.37)分]高于无卒中组(P<0.05),接受抗凝治疗患者比例低于无卒中组(P<0.05),多因素logistics回归分析显示,年龄(OR=1.062,95%CI 1.025~1.100,P<0.05)、女性(OR=2.917,95%CI 1.681~5.060,P<0.05)、LAD(OR=1.165,95%CI 1.105~1.230,P<0.05)是持续性房颤合并缺血性卒中的独立危险因素,接受抗凝治疗(OR=0.332,95%CI 0.194~0.566,P<0.05)是保护因素。结论冠心病、糖尿病是阵发性房颤患者合并缺血性卒中的独立危险因素,持续性房颤患者的年龄、女性、LAD、抗凝情况与缺血性卒中密切相关,抗凝治疗。因此,对于阵发性房颤制定相应的预防策略,或积极进行节律控制、抗凝治疗,以降低缺血性卒中风险。